Healthcare Provider Details

I. General information

NPI: 1730866179
Provider Name (Legal Business Name): DAVID ROSILLO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 07/27/2023
Certification Date: 07/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15305 RAYEN ST
NORTH HILLS CA
91343-5117
US

IV. Provider business mailing address

21313 FICUS DR UNIT 201
SANTA CLARITA CA
91321-4488
US

V. Phone/Fax

Practice location:
  • Phone: 818-892-3423
  • Fax:
Mailing address:
  • Phone: 747-895-2847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: