Healthcare Provider Details

I. General information

NPI: 1134541824
Provider Name (Legal Business Name): JODI LYNN ROSEN RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2014
Last Update Date: 04/18/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44226 10TH ST W
LANCASTER CA
93534-4134
US

IV. Provider business mailing address

44226 10TH ST W
LANCASTER CA
93534-4134
US

V. Phone/Fax

Practice location:
  • Phone: 661-433-3587
  • Fax: 661-951-9715
Mailing address:
  • Phone: 661-433-3587
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number438120
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number438120
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: