Healthcare Provider Details

I. General information

NPI: 1245731678
Provider Name (Legal Business Name): ROSETA PATATANIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2018
Last Update Date: 03/21/2025
Certification Date: 03/21/2025
Deactivation Date: 10/16/2024
Reactivation Date: 11/18/2024

III. Provider practice location address

44750 60TH ST W
LANCASTER CA
93536-7619
US

IV. Provider business mailing address

PO BOX 114
SUN VALLEY CA
91353-0114
US

V. Phone/Fax

Practice location:
  • Phone: 626-838-2608
  • Fax:
Mailing address:
  • Phone: 626-838-2608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: