Healthcare Provider Details

I. General information

NPI: 1326969064
Provider Name (Legal Business Name): STEPHANIE ROSSANO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: STEPHANIE HENSLEY

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 08/11/2026
Certification Date: 08/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 E COOLEY DR
COLTON CA
92324-3934
US

IV. Provider business mailing address

1430 E COOLEY DR
COLTON CA
92324-3934
US

V. Phone/Fax

Practice location:
  • Phone: 800-675-6694
  • Fax:
Mailing address:
  • Phone: 800-675-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: