Healthcare Provider Details

I. General information

NPI: 1295664027
Provider Name (Legal Business Name): CHELSY ROUSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/18/2026
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1735 E AVENUE J4 APT 268
LANCASTER CA
93535-6964
US

IV. Provider business mailing address

1735 E AVENUE J4 APT 268
LANCASTER CA
93535-6964
US

V. Phone/Fax

Practice location:
  • Phone: 909-238-8634
  • Fax:
Mailing address:
  • Phone: 909-238-8634
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code342000000X
TaxonomyTransportation Network Company
License NumberY2635321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: