MEDICARE: ROSA BROTHERTON

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	390200000X	Student in an Organized Health Care Education/Training Program
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1770149668
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA BROTHERTON

Provider Business Mailing Address
First Line	:	2904 W SUNSET BLVD STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7308
Country	:	US
Telephone Number	:	213-534-7013
Fax Number	:

Provider Business Practice Location Address
First Line	:	2904 W SUNSET BLVD STE 6
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-7308
Country	:	US
Telephone Number	:	213-534-7013
Fax Number	:

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

Provider Enumeration Date	:	05/15/2019
Last Update Date	:	09/20/2022

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Directions to “ ROSA BROTHERTON ” Practice Location

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