Healthcare Provider Details

I. General information

NPI: 1265913339
Provider Name (Legal Business Name): ROSE HUSTON RRT-SDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9961 SIERRA AVE
FONTANA CA
92335-6720
US

IV. Provider business mailing address

9961 SIERRA AVE # MOB7
FONTANA CA
92335-6720
US

V. Phone/Fax

Practice location:
  • Phone: 909-427-5434
  • Fax:
Mailing address:
  • Phone: 909-427-5434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number32092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: