Healthcare Provider Details

I. General information

NPI: 1255525465
Provider Name (Legal Business Name): RANDY L.EE ROZAR MFTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: RAND LEE ROZAR MFTI

II. Dates (important events)

Enumeration Date: 08/30/2007
Last Update Date: 09/28/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

31681 RIVERSIDE DR SUITE L
LAKE ELSINORE CA
92530-7815
US

IV. Provider business mailing address

31681 RIVERSIDE DR SUITE L
LAKE ELSINORE CA
92530-7815
US

V. Phone/Fax

Practice location:
  • Phone: 951-674-9243
  • Fax: 951-674-9635
Mailing address:
  • Phone: 951-674-9243
  • Fax: 951-674-9635

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number49449
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: