Healthcare Provider Details

I. General information

NPI: 1295181303
Provider Name (Legal Business Name): DOROTHY MASAE ROSERO 4406
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MASAE DOROTHY ROSERO 4406

II. Dates (important events)

Enumeration Date: 05/06/2016
Last Update Date: 05/06/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 MANHATTAN AVE
FULLERTON CA
92831-5221
US

IV. Provider business mailing address

1421 MANHATTAN AVE
FULLERTON CA
92831-5221
US

V. Phone/Fax

Practice location:
  • Phone: 818-489-4785
  • Fax:
Mailing address:
  • Phone: 714-300-6144
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number4406
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: