Healthcare Provider Details

I. General information

NPI: 1912628694
Provider Name (Legal Business Name): ROSA ADAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2022
Last Update Date: 09/09/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S 5TH ST
EL CENTRO CA
92243-3013
US

IV. Provider business mailing address

807 SCOTT AVE
EL CENTRO CA
92243-1709
US

V. Phone/Fax

Practice location:
  • Phone: 760-482-0864
  • Fax: 760-482-9185
Mailing address:
  • Phone: 442-456-0048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: