Provider Demographics
NPI:1295181303
Name:ROSERO, DOROTHY MASAE (4406)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:MASAE
Last Name:ROSERO
Suffix:
Gender:F
Credentials:4406
Other - Prefix:
Other - First Name:MASAE
Other - Middle Name:DOROTHY
Other - Last Name:ROSERO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:4406
Mailing Address - Street 1:1421 MANHATTAN AVE
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92831-5221
Mailing Address - Country:US
Mailing Address - Phone:714-300-6144
Mailing Address - Fax:
Practice Address - Street 1:1421 MANHATTAN AVE
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92831-5221
Practice Address - Country:US
Practice Address - Phone:818-489-4785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-06
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4406247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other