Healthcare Provider Details

I. General information

NPI: 1205080249
Provider Name (Legal Business Name): GERI ROSA RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2008
Last Update Date: 11/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10012 NORWALK BLVD STE 110
SANTA FE SPRINGS CA
90670-3363
US

IV. Provider business mailing address

10012 NORWALK BLVD STE 110
SANTA FE SPRINGS CA
90670-3363
US

V. Phone/Fax

Practice location:
  • Phone: 562-906-1335
  • Fax: 562-906-1314
Mailing address:
  • Phone: 562-906-1335
  • Fax: 562-906-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License NumberRN 414903
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: