Healthcare Provider Details

I. General information

NPI: 1255294138
Provider Name (Legal Business Name): NAHOMI ROSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7260 LINDA VISTA RD
SAN DIEGO CA
92111-6128
US

IV. Provider business mailing address

2071 WATERBURY
CHULA VISTA CA
91913-2313
US

V. Phone/Fax

Practice location:
  • Phone: 858-496-1613
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250057533
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: