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General NPI Number Information
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NPI Number | 1861076267
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Entity Type | Individual
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Provider Name | KELSEA ROSE PA
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Gender | Female
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Dates
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Enumeration Date | 05/11/2021
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 14764 WICKS BLVD
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City | SAN LEANDRO
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State | CA
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Zip | 94577-6718
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Country | US
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Telephone | 510-363-0051
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 WALNUT AVE APT 2215
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City | FREMONT
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State | CA
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Zip | 94536-4396
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Country | US
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Telephone | 954-804-2464
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 59232
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License Number State | CA
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