Healthcare Provider Details

I. General information

NPI: 1700355583
Provider Name (Legal Business Name): JESSICA A ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2018
Last Update Date: 05/17/2021
Certification Date: 05/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3322 SWEETWATER SPRINGS BLVD STE 104
SPRING VALLEY CA
91977-3142
US

IV. Provider business mailing address

10130 AUSTIN DR APT 36
SPRING VALLEY CA
91977-6908
US

V. Phone/Fax

Practice location:
  • Phone: 619-733-3898
  • Fax:
Mailing address:
  • Phone: 760-687-8119
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: