Provider Demographics
NPI:1275799983
Name:ROSE, STILEDA PATRICE (MED)
Entity Type:Individual
Prefix:MS
First Name:STILEDA
Middle Name:PATRICE
Last Name:ROSE
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 N TUCSON BLVD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85716-1827
Mailing Address - Country:US
Mailing Address - Phone:520-232-6700
Mailing Address - Fax:520-232-6701
Practice Address - Street 1:2945 N TUCSON BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85716-1827
Practice Address - Country:US
Practice Address - Phone:520-232-6700
Practice Address - Fax:520-232-6701
Is Sole Proprietor?:No
Enumeration Date:2008-08-01
Last Update Date:2008-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool