Healthcare Provider Details

I. General information

NPI: 1538255914
Provider Name (Legal Business Name): ROSE HIU PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. ROSE MEISENZAHL

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 11/27/2023
Certification Date: 11/02/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E DUARTE RD
DUARTE CA
91010
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8111
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364SX0200X
TaxonomyOncology Clinical Nurse Specialist
License NumberPA15715
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: