Healthcare Provider Details

I. General information

NPI: 1962907162
Provider Name (Legal Business Name): ANDREW ROSARIO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2018
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14895 E 14TH ST STE 465
SAN LEANDRO CA
94578-2989
US

IV. Provider business mailing address

14895 E 14TH ST STE 465
SAN LEANDRO CA
94578-2989
US

V. Phone/Fax

Practice location:
  • Phone: 510-346-7100
  • Fax: 510-346-7101
Mailing address:
  • Phone: 510-346-7100
  • Fax: 514-346-7101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: