Provider Demographics
NPI:1407983919
Name:CALLEROS, ROSEMARIE (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:ROSEMARIE
Middle Name:
Last Name:CALLEROS
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26461 CROWN VALLEY PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6377
Mailing Address - Country:US
Mailing Address - Phone:949-916-8271
Mailing Address - Fax:949-716-8033
Practice Address - Street 1:26461 CROWN VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6377
Practice Address - Country:US
Practice Address - Phone:949-916-8271
Practice Address - Fax:949-916-8271
Is Sole Proprietor?:No
Enumeration Date:2007-02-28
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 12881103T00000X
CAMFC 18234106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
R64214Medicare UPIN