Healthcare Provider Details

I. General information

NPI: 1396281408
Provider Name (Legal Business Name): ROZAN FAOURI B.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2017
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11227 VALLEY BLVD
EL MONTE CA
91731-3225
US

IV. Provider business mailing address

11227 VALLEY BLVD
EL MONTE CA
91731-3225
US

V. Phone/Fax

Practice location:
  • Phone: 626-444-0705
  • Fax:
Mailing address:
  • Phone: 626-444-0705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: