Healthcare Provider Details

I. General information

NPI: 1932819562
Provider Name (Legal Business Name): HARRY ROSEDALE III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2022
Last Update Date: 04/06/2026
Certification Date: 04/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

947 N LA CIENEGA BLVD
WEST HOLLYWOOD CA
90069-4782
US

IV. Provider business mailing address

947 N LA CIENEGA BLVD
LOS ANGELES CA
90069-4782
US

V. Phone/Fax

Practice location:
  • Phone: 626-622-6297
  • Fax:
Mailing address:
  • Phone: 626-622-6297
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160724
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: