MEDICARE: BRANDON ROSAS

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1619513140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRANDON ROSAS

Provider Business Mailing Address
First Line	:	285 MOSS ST UNIT 5
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-2150
Country	:	US
Telephone Number	:	619-240-2735
Fax Number	:

Provider Business Practice Location Address
First Line	:	285 MOSS ST UNIT 5
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-2150
Country	:	US
Telephone Number	:	619-240-2735
Fax Number	:

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

Provider Enumeration Date	:	11/19/2019
Last Update Date	:	11/19/2019

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Directions to “ BRANDON ROSAS ” Practice Location

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