Healthcare Provider Details

I. General information

NPI: 1487121786
Provider Name (Legal Business Name): ROSANNA THAI - UNITT MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROSANNA THAI MS

II. Dates (important events)

Enumeration Date: 10/25/2018
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

780 SHADOWRIDGE DR
VISTA CA
92083-7986
US

IV. Provider business mailing address

780 SHADOWRIDGE DR
VISTA CA
92083-7986
US

V. Phone/Fax

Practice location:
  • Phone: 833-574-2273
  • Fax:
Mailing address:
  • Phone: 833-574-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number15672
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: