Healthcare Provider Details

I. General information

NPI: 1215873476
Provider Name (Legal Business Name): ROSEMARY LISBETH MALDONADO LPT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2405
US

IV. Provider business mailing address

9101 WHITTIER BLVD
PICO RIVERA CA
90660-2405
US

V. Phone/Fax

Practice location:
  • Phone: 562-801-4626
  • Fax:
Mailing address:
  • Phone: 562-801-4626
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code167G00000X
TaxonomyLicensed Psychiatric Technician
License Number42653
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: