Healthcare Provider Details

I. General information

NPI: 1255294195
Provider Name (Legal Business Name): AMARYLIS ROSSY ROJAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 CONCORD AVE STE 185
CONCORD CA
94520-5006
US

IV. Provider business mailing address

916 S GLENDORA AVE
GLENDORA CA
91740-6308
US

V. Phone/Fax

Practice location:
  • Phone: 510-268-8120
  • Fax: 510-268-8120
Mailing address:
  • Phone: 626-327-6869
  • Fax: 626-327-6869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1234
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: