Provider Demographics
NPI:1275245904
Name:ROSAS, OMAR BRANDO
Entity Type:Individual
Prefix:
First Name:OMAR
Middle Name:BRANDO
Last Name:ROSAS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21600 OXNARD STREET
Mailing Address - Street 2:
Mailing Address - City:WOODLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:91367
Mailing Address - Country:US
Mailing Address - Phone:323-506-1601
Mailing Address - Fax:
Practice Address - Street 1:21600 OXNARD STREET
Practice Address - Street 2:
Practice Address - City:WOODLANDS
Practice Address - State:CA
Practice Address - Zip Code:91367
Practice Address - Country:US
Practice Address - Phone:323-506-1601
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-13
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician