Healthcare Provider Details

I. General information

NPI: 1902477201
Provider Name (Legal Business Name): MARIA JASMIN DE ROSAS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date: 07/15/2021
Reactivation Date: 05/21/2026

III. Provider practice location address

20101 HAMILTON AVE STE 160
TORRANCE CA
90502-1306
US

IV. Provider business mailing address

20101 HAMILTON AVE STE 160
TORRANCE CA
90502-1306
US

V. Phone/Fax

Practice location:
  • Phone: 310-817-2177
  • Fax: 310-817-2178
Mailing address:
  • Phone: 310-817-2177
  • Fax: 310-817-2178

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: