1215195425 NPI number — ROSALIE ANNE BLOOMBERG-RISSMAN L.C.S.W.

Table of content: ROSALIE ANNE BLOOMBERG-RISSMAN L.C.S.W. (NPI 1215195425)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215195425 NPI number — ROSALIE ANNE BLOOMBERG-RISSMAN L.C.S.W.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLOOMBERG-RISSMAN
Provider First Name:
ROSALIE
Provider Middle Name:
ANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
L.C.S.W.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1215195425
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3003 HEALTH CENTER DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92123-2700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-939-4129
Provider Business Mailing Address Fax Number:
858-939-4248

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
325 W WASHINGTON ST STE 3016
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92103-1946
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-324-9830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/26/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 24627 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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