Healthcare Provider Details

I. General information

NPI: 1477169613
Provider Name (Legal Business Name): ANA M URENA ROSARIO MSED, MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2020
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

714 W OLYMPIC BLVD STE 742
LOS ANGELES CA
90015-1026
US

IV. Provider business mailing address

714 W OLYMPIC BLVD STE 742
LOS ANGELES CA
90015-1026
US

V. Phone/Fax

Practice location:
  • Phone: 323-356-0210
  • Fax:
Mailing address:
  • Phone: 323-356-0210
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberLEP4542
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: