MEDICARE: ALYSSA ROSE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1033375811
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA ROSE

Provider Business Mailing Address
First Line	:	4409 BELCREST WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3343
Country	:	US
Telephone Number	:	916-482-1482
Fax Number	:

Provider Business Practice Location Address
First Line	:	4409 BELCREST WAY
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95821-3343
Country	:	US
Telephone Number	:	916-482-1482
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2008
Last Update Date	:	07/22/2013

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Directions to “ ALYSSA ROSE ” Practice Location

Language	Start Address	Practice Location

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