MEDICARE: MS. ROSA MARIA ROSALES MFT INTERN

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	106H00000X	Marriage & Family Therapist	IMF70200	CA

General Provider Information

NPI Number	:	1578859211
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ROSA MARIA ROSALES MFT INTERN

Provider Business Mailing Address
First Line	:	40 E MINARETS AVE
Second Line	:
City	:	PINEDALE
State	:	CA
Zip	:	93650-1239
Country	:	US
Telephone Number	:	559-436-0482
Fax Number	:	559-436-4650

Provider Business Practice Location Address
First Line	:	40 E MINARETS AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93650-1239
Country	:	US
Telephone Number	:	559-436-0482
Fax Number	:	559-436-4650

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

Provider Enumeration Date	:	06/21/2011
Last Update Date	:	12/14/2015

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