Provider Demographics
NPI:1114455839
Name:HSU, DULCE ROCIO
Entity Type:Individual
Prefix:
First Name:DULCE
Middle Name:ROCIO
Last Name:HSU
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 1:3301 E 12TH ST STE 259
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2940
Mailing Address - Country:US
Mailing Address - Phone:915-342-2925
Mailing Address - Fax:
Practice Address - Street 1:3301 E 12TH ST STE 259
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-2940
Practice Address - Country:US
Practice Address - Phone:915-342-2925
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-24
Last Update Date:2021-04-27
Deactivation Date:2018-09-25
Deactivation Code:
Reactivation Date:2018-10-03
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CA108202106H00000X, 390200000X
CA125684106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program