Healthcare Provider Details

I. General information

NPI: 1295958874
Provider Name (Legal Business Name): LAURA ROSSI PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/11/2007
Last Update Date: 10/30/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1939 W VISTA WAY
VISTA CA
92083-6019
US

IV. Provider business mailing address

1939 W VISTA WAY
VISTA CA
92083-6019
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-7528
  • Fax: 760-509-4410
Mailing address:
  • Phone: 760-305-7528
  • Fax: 760-509-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License NumberPSY 22465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: