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General NPI Number Information
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NPI Number | 1144889064
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Entity Type | Individual
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Provider Name | STEPHEN M ROOS
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Gender | Male
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Dates
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Enumeration Date | 06/13/2019
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Last Update Date | 06/13/2019
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Provider Practice Location Address
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Address Line | 105 HOSPITAL RD
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City | SONORA
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State | CA
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Zip | 95370-5227
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Country | US
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Telephone | 209-533-6245
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Fax |
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Provider Business Mailing Address
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Address Line | 2 S GREEN ST
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City | SONORA
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State | CA
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Zip | 95370-4618
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Country | US
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Telephone | 209-533-6245
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | AMFT112531
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License Number State | CA
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