Healthcare Provider Details

I. General information

NPI: 1679518138
Provider Name (Legal Business Name): MS. ROSHANN RENE REESE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 08/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

191 S SAN GABRIEL BLVD
PASADENA CA
91107-4839
US

IV. Provider business mailing address

191 S SAN GABRIEL BLVD
PASADENA CA
91107-4839
US

V. Phone/Fax

Practice location:
  • Phone: 626-676-4168
  • Fax: 626-507-8148
Mailing address:
  • Phone: 626-676-4168
  • Fax: 626-507-8148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number566078
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number566078
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number566078
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: