Healthcare Provider Details

I. General information

NPI: 1740115286
Provider Name (Legal Business Name): ROSALINDA MARCOS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2026
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21 RANCHO CAMINO DR FL 2
POMONA CA
91766-7019
US

IV. Provider business mailing address

670 W FIREWEED LN STE 160
ANCHORAGE AK
99503-2561
US

V. Phone/Fax

Practice location:
  • Phone: 909-634-3974
  • Fax: 855-864-1494
Mailing address:
  • Phone: 907-770-0862
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberE1905147
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: