Provider Demographics
NPI:1033681549
Name:ROSAS, GUILLERMINA VIVEROS
Entity Type:Individual
Prefix:
First Name:GUILLERMINA
Middle Name:VIVEROS
Last Name:ROSAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9262 BEGONIA AVE
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92344-4615
Mailing Address - Country:US
Mailing Address - Phone:951-892-9646
Mailing Address - Fax:
Practice Address - Street 1:1205 RENAISSANCE PKWY UNIT 420
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-2417
Practice Address - Country:US
Practice Address - Phone:909-543-0317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-21
Last Update Date:2018-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32454126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant