1992281216 NPI number — MISS CYNTHIA JOHANNA ROSA MSW

Table of content: MISS CYNTHIA JOHANNA ROSA MSW (NPI 1992281216)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992281216 NPI number — MISS CYNTHIA JOHANNA ROSA MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSA
Provider First Name:
CYNTHIA
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MISS
Provider Name Suffix Text:
Provider Credential Text:
MSW
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:
1992281216
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1247 E 87TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90002-1203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2150 W 190TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TORRANCE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90504-6103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-768-1635
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/19/2018

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:  83514 , 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)

  • Identifier: NA . This is a "NA" identifier . This identifiers is of the category "OTHER".




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