Healthcare Provider Details

I. General information

NPI: 1669740544
Provider Name (Legal Business Name): ROSA ISELA LARIOS M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2011
Last Update Date: 04/04/2025
Certification Date: 04/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 S ATLANTIC BLVD SUITE 101
COMMERCE CA
90040-1200
US

IV. Provider business mailing address

3060 PANORAMA RD APT 9
RIVERSIDE CA
92506-1400
US

V. Phone/Fax

Practice location:
  • Phone: 323-318-9960
  • Fax:
Mailing address:
  • Phone: 310-722-0574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number66891
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number106088
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: