Healthcare Provider Details

I. General information

NPI: 1083491369
Provider Name (Legal Business Name): CHRIS JARED ROTEMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2023
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

327 COLLEGE AVE
SANTA ROSA CA
95401-5117
US

IV. Provider business mailing address

713 W COMMONWEALTH AVE STE C
FULLERTON CA
92832-1612
US

V. Phone/Fax

Practice location:
  • Phone: 707-568-2800
  • Fax:
Mailing address:
  • Phone: 714-879-4274
  • Fax: 714-879-2274

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: