=====================================================
General NPI Number Information
=====================================================
NPI Number | 1669896551
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROSE CALLENDER FNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/12/2014
-----------------------------------------------------
Last Update Date | 10/06/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 790 E. FOOTHILL BLVD.
-----------------------------------------------------
City | RIALTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92376-5269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-546-7135
-----------------------------------------------------
Fax | 877-778-9467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 OCEANGATE SUITE 100
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90802-4317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-499-6191
-----------------------------------------------------
Fax | 877-778-9467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 95000207
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 842294
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------