Healthcare Provider Details

I. General information

NPI: 1831567569
Provider Name (Legal Business Name): MS. MARIETONI YELO ROSURE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2015
Last Update Date: 02/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

106 DISCOVERY
IRVINE CA
92618-3131
US

IV. Provider business mailing address

106 DISCOVERY
IRVINE CA
92618-3131
US

V. Phone/Fax

Practice location:
  • Phone: 949-203-8877
  • Fax:
Mailing address:
  • Phone: 949-203-8877
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: