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General NPI Number Information
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NPI Number | 1437944139
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Entity Type | Individual
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Provider Name | DR. ROSEMARY MIMI MARIE AMARAL
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Gender | Female
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Dates
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Enumeration Date | 04/12/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | 720 PETALUMA BLVD S APT 52
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City | PETALUMA
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State | CA
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Zip | 94952-5149
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Country | US
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Telephone | 707-338-3863
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Fax |
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Provider Business Mailing Address
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Address Line | 4361 TELLER AVE SUITE #100
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City | NEW PORT BEACH
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State | CA
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Zip | 92660
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Country | US
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Telephone | 718-788-7949
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSB94027138
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License Number State | CA
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