MEDICARE: ROSE TIANA VIOLET GLASS

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	171400000X	Health & Wellness Coach		CA

General Provider Information

NPI Number	:	1487444816
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSE TIANA VIOLET GLASS

Provider Business Mailing Address
First Line	:	4632 WALNUT DR
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-6523
Country	:	US
Telephone Number	:	707-845-7683
Fax Number	:

Provider Business Practice Location Address
First Line	:	4632 WALNUT DR
Second Line	:
City	:	EUREKA
State	:	CA
Zip	:	95503-6523
Country	:	US
Telephone Number	:	707-845-7683
Fax Number	:

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

Provider Enumeration Date	:	05/08/2025
Last Update Date	:	05/08/2025

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Directions to “ ROSE TIANA VIOLET GLASS ” Practice Location

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