Healthcare Provider Details

I. General information

NPI: 1730578154
Provider Name (Legal Business Name): ROXANNE FERRER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/22/2015
Last Update Date: 01/22/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8029 CALICO ST
SAN DIEGO CA
92126
US

IV. Provider business mailing address

8029 CALICO ST
SAN DIEGO CA
92126
US

V. Phone/Fax

Practice location:
  • Phone: 619-502-0050
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberOTA2059
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: