MEDICARE: MISS ROSE MARY ORNELAS

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	1041C0700X	Clinical Social Worker	LCS21728	CA

General Provider Information

NPI Number	:	1760535603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ROSE MARY ORNELAS

Provider Business Mailing Address
First Line	:	4411 E KINGS CANYON RD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3604
Country	:	US
Telephone Number	:	559-600-6083
Fax Number	:

Provider Business Practice Location Address
First Line	:	4468 E CESAR CHAVEZ BLVD
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93702-3605
Country	:	US
Telephone Number	:	559-600-6083
Fax Number	:

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	12/13/2024

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Directions to “ MISS ROSE MARY ORNELAS ” Practice Location

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