Healthcare Provider Details

I. General information

NPI: 1093155293
Provider Name (Legal Business Name): ROSE SESI
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2013
Last Update Date: 04/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 S MAGNOLIA AVE SUITE 201
EL CAJON CA
92020-5237
US

IV. Provider business mailing address

436 S MAGNOLIA AVE SUITE 201
EL CAJON CA
92020-5237
US

V. Phone/Fax

Practice location:
  • Phone: 619-631-7400
  • Fax:
Mailing address:
  • Phone: 619-631-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: