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General NPI Number Information
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NPI Number | 1801429386
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Entity Type | Individual
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Provider Name | ROSAMARIA ELVARA RUCOBO
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Gender | Female
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Dates
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Enumeration Date | 02/13/2020
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Last Update Date | 02/13/2020
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Provider Practice Location Address
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Address Line | 639 ADAMS AVE
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City | LOS BANOS
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State | CA
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Zip | 93635-4701
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Country | US
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Telephone | 209-519-8269
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Fax |
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Provider Business Mailing Address
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Address Line | 2863 STILT LN
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City | LOS BANOS
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State | CA
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Zip | 93635-9469
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Country | US
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Telephone |
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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 | 2355S0801X
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Taxonomy Name | Speech-Language Assistant
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License Number |
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License Number State |
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