Healthcare Provider Details

I. General information

NPI: 1174993604
Provider Name (Legal Business Name): ARLENE ARETHA TAYLOR ROSE MSN, PMHNP-BC, CCRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 03/11/2025
Certification Date: 03/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8453 FIR DR APT D
RANCHO CUCAMONGA CA
91730-4160
US

IV. Provider business mailing address

113 N SAN VICENTE BLVD STE 253
BEVERLY HILLS CA
90211-2329
US

V. Phone/Fax

Practice location:
  • Phone: 818-473-0156
  • Fax: 641-207-4228
Mailing address:
  • Phone: 424-209-4500
  • Fax: 818-450-0611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number78207
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License Number716641
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number78207
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State
# 7
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number95006428
License Number StateCA
# 8
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1099329
License Number StateCA
# 9
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95006428
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: