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NPI Code Detail

MEDICARE: MS. ROSALIE C DE VERA M.ED.

MEDICARE: MS. ROSALIE C DE VERA M.ED.
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
1103TS0200XSchool PsychologistCA

General Provider Information

NPI Number : 1346062924
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. ROSALIE C DE VERA M.ED.
Provider Business Mailing Address
First Line : 5450 SNYDER LN
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-2906
Country : US
Telephone Number : 707-792-4756
Fax Number :
Provider Business Practice Location Address
First Line : 5450 SNYDER LN
Second Line :
City : ROHNERT PARK
State : CA
Zip : 94928-2906
Country : US
Telephone Number : 707-792-4750
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/25/2024
Last Update Date : 10/25/2024

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