Healthcare Provider Details

I. General information

NPI: 1154243046
Provider Name (Legal Business Name): TIARA SHANELL KING-ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TIARA SHANELL KING

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2108 N ST STE N
SACRAMENTO CA
95816-5712
US

IV. Provider business mailing address

531 N CIVIC DR APT D
WALNUT CREEK CA
94597-3254
US

V. Phone/Fax

Practice location:
  • Phone: 510-383-0847
  • Fax:
Mailing address:
  • Phone: 510-383-0847
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: