Healthcare Provider Details

I. General information

NPI: 1376338590
Provider Name (Legal Business Name): ROCCO JARED BISCOTTI
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 S SUNWEST LN STE 200
SAN BERNARDINO CA
92408-3248
US

IV. Provider business mailing address

1950 S SUNWEST LN STE 200
SAN BERNARDINO CA
92408-3248
US

V. Phone/Fax

Practice location:
  • Phone: 909-252-4017
  • Fax:
Mailing address:
  • Phone: 909-252-4017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number164769
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: