Healthcare Provider Details

I. General information

NPI: 1073765913
Provider Name (Legal Business Name): ROSSANA ROSALES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/22/2008
Last Update Date: 10/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1240 N MISSION RD
LOS ANGELES CA
90033-1019
US

IV. Provider business mailing address

5516 MAGNOLIA AVE
WHITTIER CA
90601-2750
US

V. Phone/Fax

Practice location:
  • Phone: 323-226-3106
  • Fax: 323-226-2829
Mailing address:
  • Phone: 562-695-1507
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number16366
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: