Provider Demographics
NPI:1497067623
Name:ROSBOROUGH, CLANAE
Entity Type:Individual
Prefix:
First Name:CLANAE
Middle Name:
Last Name:ROSBOROUGH
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 1:10221 COMPTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90002-2802
Mailing Address - Country:US
Mailing Address - Phone:213-385-5100
Mailing Address - Fax:323-566-1638
Practice Address - Street 1:10221 COMPTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90002-2802
Practice Address - Country:US
Practice Address - Phone:213-385-5100
Practice Address - Fax:323-566-1638
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-02
Last Update Date:2010-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner