Healthcare Provider Details

I. General information

NPI: 1457230294
Provider Name (Legal Business Name): FATIMA SARAY ROSAS MALDONADO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2025
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

IV. Provider business mailing address

784 HIGH ST
SAN LUIS OBISPO CA
93401-5243
US

V. Phone/Fax

Practice location:
  • Phone: 805-540-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: