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NPI Code Detail

MEDICARE: EDLA SAINT ROSE

MEDICARE: EDLA SAINT 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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1255283933
Entity Type Code : Individual
Provider Name (Legal Business Name) : EDLA SAINT ROSE
Provider Business Mailing Address
First Line : 100 N PACIFIC COAST HWY STE 1400
Second Line :
City : EL SEGUNDO
State : CA
Zip : 90245-5602
Country : US
Telephone Number : 949-357-2556
Fax Number : 949-357-2556
Provider Business Practice Location Address
First Line : 2 GRANITE AVE STE 260
Second Line :
City : MILTON
State : MA
Zip : 02186-4381
Country : US
Telephone Number : 617-812-9454
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2026
Last Update Date : 02/13/2026

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Directions to “ EDLA SAINT ROSE ” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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