Healthcare Provider Details

I. General information

NPI: 1134073844
Provider Name (Legal Business Name): ROSA MARITZA FERNANDEZ RECINOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2026
Last Update Date: 02/21/2026
Certification Date: 02/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

74119 CATALINA WAY
PALM DESERT CA
92260-3004
US

IV. Provider business mailing address

74119 CATALINA WAY
PALM DESERT CA
92260-3004
US

V. Phone/Fax

Practice location:
  • Phone: 626-695-3499
  • Fax:
Mailing address:
  • Phone: 626-695-3499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number734838
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: