Provider Demographics
NPI:1083354351
Name:ROSALES, GUADALUPE JR
Entity Type:Individual
Prefix:MISS
First Name:GUADALUPE
Middle Name:
Last Name:ROSALES
Suffix:JR
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 1:15123 BROOKHURST ST APT 443
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-6066
Mailing Address - Country:US
Mailing Address - Phone:714-722-2399
Mailing Address - Fax:714-610-0043
Practice Address - Street 1:15123 BROOKHURST ST APT 443
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-6066
Practice Address - Country:US
Practice Address - Phone:714-722-2399
Practice Address - Fax:714-610-0043
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2022-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAY5080368376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide