Healthcare Provider Details

I. General information

NPI: 1457139578
Provider Name (Legal Business Name): MATTHEW ROSEN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2023
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

877 YGNACIO VALLEY RD STE 100
WALNUT CREEK CA
94596-3897
US

IV. Provider business mailing address

119 W TORRANCE BLVD STE 100
REDONDO BEACH CA
90277-3600
US

V. Phone/Fax

Practice location:
  • Phone: 925-482-3330
  • Fax: 925-482-3333
Mailing address:
  • Phone: 310-374-3300
  • Fax: 310-374-3307

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-90711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: