Healthcare Provider Details

I. General information

NPI: 1669303566
Provider Name (Legal Business Name): DIANA ROSAS RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/28/2026
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SAN LEANDRO BLVD
SAN LEANDRO CA
94577-1595
US

IV. Provider business mailing address

1954 MCPATT PL
STOCKTON CA
95206-3663
US

V. Phone/Fax

Practice location:
  • Phone: 510-605-7147
  • Fax:
Mailing address:
  • Phone: 510-924-6304
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number95451878
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: