Provider Demographics
NPI:1346709508
Name:ROSE, JOHANNE
Entity Type:Individual
Prefix:
First Name:JOHANNE
Middle Name:
Last Name:ROSE
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 1:141 BARDSDALE AVE
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93035-4502
Mailing Address - Country:US
Mailing Address - Phone:805-616-9973
Mailing Address - Fax:805-650-0996
Practice Address - Street 1:4564 TELEPHONE RD STE 805
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-5661
Practice Address - Country:US
Practice Address - Phone:805-616-9973
Practice Address - Fax:805-650-0997
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-18
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2798171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist