Healthcare Provider Details

I. General information

NPI: 1922509934
Provider Name (Legal Business Name): LETICIA ROSAS VERA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39899 BALENTINE DR STE 200
NEWARK CA
94560-5361
US

IV. Provider business mailing address

16328 BLANCO ST
ASHLAND CA
94578-3126
US

V. Phone/Fax

Practice location:
  • Phone: 510-820-4080
  • Fax:
Mailing address:
  • Phone: 510-820-4080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-53404
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: