Healthcare Provider Details

I. General information

NPI: 1235762238
Provider Name (Legal Business Name): ROSANGELICA JUAREZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2020
Last Update Date: 05/16/2025
Certification Date: 05/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 GIBSON DR STE 100
ROSEVILLE CA
95678-5792
US

IV. Provider business mailing address

516 GIBSON DR STE 100
ROSEVILLE CA
95678-5792
US

V. Phone/Fax

Practice location:
  • Phone: 916-774-6802
  • Fax:
Mailing address:
  • Phone: 916-774-6802
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: