Healthcare Provider Details

I. General information

NPI: 1962744466
Provider Name (Legal Business Name): ROSA ELENA SANDERSON RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSA ELENA SANDERSON RN

II. Dates (important events)

Enumeration Date: 03/22/2013
Last Update Date: 03/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1115 N IMPERIAL AVE
EL CENTRO CA
92243-1739
US

IV. Provider business mailing address

PO BOX 509
CALEXICO CA
92232-0509
US

V. Phone/Fax

Practice location:
  • Phone: 760-336-4694
  • Fax:
Mailing address:
  • Phone: 702-595-0097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number818839
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: