Healthcare Provider Details

I. General information

NPI: 1902123714
Provider Name (Legal Business Name): JANE PACHECO ROSETE MSN, NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2010
Last Update Date: 05/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1245 WILSHIRE BLVD STE 305
LOS ANGELES CA
90017-4803
US

IV. Provider business mailing address

1245 WILSHIRE BLVD STE 305
LOS ANGELES CA
90017-4803
US

V. Phone/Fax

Practice location:
  • Phone: 213-481-2211
  • Fax: 213-977-0656
Mailing address:
  • Phone: 213-481-2211
  • Fax: 213-977-0656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number19463
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: