Provider Demographics
NPI:1255009965
Name:VALLE-RICO, ROSA MARIA
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:VALLE-RICO
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 1:526 E CHAPEL ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-4520
Mailing Address - Country:US
Mailing Address - Phone:805-455-3795
Mailing Address - Fax:
Practice Address - Street 1:526 E CHAPEL ST
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-4520
Practice Address - Country:US
Practice Address - Phone:805-455-3795
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2021-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA119822106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty