Provider Demographics
NPI:1083870422
Name:ROSELLO, ELENITA MANARAN (RN)
Entity Type:Individual
Prefix:
First Name:ELENITA
Middle Name:MANARAN
Last Name:ROSELLO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:ELENITA
Other - Middle Name:
Other - Last Name:ROSELLO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10833 LE CONTE AVE
Mailing Address - Street 2:12-311 MDCC
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-3075
Mailing Address - Country:US
Mailing Address - Phone:310-825-6244
Mailing Address - Fax:310-206-5843
Practice Address - Street 1:10833 LE CONTE AVE
Practice Address - Street 2:12-311 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-3075
Practice Address - Country:US
Practice Address - Phone:310-825-6244
Practice Address - Fax:310-206-5843
Is Sole Proprietor?:No
Enumeration Date:2008-08-05
Last Update Date:2008-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA547804163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse