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General NPI Number Information
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NPI Number | 1508095969
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Entity Type | Individual
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Provider Name | ALISON ROSEN B.IND PSYCH LMT CMT
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Gender | Female
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Dates
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Enumeration Date | 07/07/2009
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Last Update Date | 07/07/2009
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Provider Practice Location Address
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Address Line | 42505 RANCH CLUB ROAD LAKE ELIZABETH GOLF AND RANCH CLUB
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City | ELIZABETH LAKE
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State | CA
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Zip | 93532
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Country | US
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Telephone | 661-435-3142
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Fax | 267-948-5144
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Provider Business Mailing Address
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Address Line | PO BOX 406
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City | LAKE HUGHES
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State | CA
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Zip | 93532-0406
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Country | US
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Telephone | 661-435-3142
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Fax | 267-948-5144
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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 | 225700000X
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Taxonomy Name | Massage Therapist
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License Number | 10010915
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License Number State | CA
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