Healthcare Provider Details

I. General information

NPI: 1043510209
Provider Name (Legal Business Name): ROSA LUTRARIO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/21/2010
Last Update Date: 10/09/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 E 12TH ST
OAKLAND CA
94601-3463
US

IV. Provider business mailing address

759 S VAN NESS AVE (SECOND FLOOR)
SAN FRANCISCO CA
94110-1908
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-3700
  • Fax: 510-535-4216
Mailing address:
  • Phone: 415-642-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number68921
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW33729
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: