Healthcare Provider Details

I. General information

NPI: 1043502230
Provider Name (Legal Business Name): ANGELA ROSA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 GALLETTI WAY #8B
RENO NV
89431-5564
US

IV. Provider business mailing address

15205 N TIMBERLINE DR
RENO NV
89511
US

V. Phone/Fax

Practice location:
  • Phone: 775-333-0943
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: