Healthcare Provider Details

I. General information

NPI: 1780503045
Provider Name (Legal Business Name): DANIELA A BERTON ROSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/13/2026
Last Update Date: 07/13/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4103 S YALE AVE
TULSA OK
74135-6002
US

IV. Provider business mailing address

6716 S OSWEGO AVE
TULSA OK
74136-2834
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-6699
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: