Healthcare Provider Details

I. General information

NPI: 1689291775
Provider Name (Legal Business Name): ROSA WACHTEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSA SAMBUCETO

II. Dates (important events)

Enumeration Date: 07/06/2020
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 NORMAL ST
SAN DIEGO CA
92103-2653
US

IV. Provider business mailing address

13074 MARITIME PL
SAN DIEGO CA
92130-1817
US

V. Phone/Fax

Practice location:
  • Phone: 619-725-5501
  • Fax:
Mailing address:
  • Phone: 650-400-9602
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: