Healthcare Provider Details

I. General information

NPI: 1609650977
Provider Name (Legal Business Name): KATHERINE D ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25109 JEFFERSON AVE STE 200
MURRIETA CA
92562-8117
US

IV. Provider business mailing address

25109 JEFFERSON AVE STE 200
MURRIETA CA
92562-8117
US

V. Phone/Fax

Practice location:
  • Phone: 951-297-7773
  • Fax:
Mailing address:
  • Phone: 951-297-7773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number123897
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: