Provider Demographics
NPI:1528209533
Name:ROSALES, JENNIFER LYNN
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:LYNN
Last Name:ROSALES
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 1:2930 INLAND EMPIRE BLVD
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-4802
Mailing Address - Country:US
Mailing Address - Phone:909-957-5564
Mailing Address - Fax:
Practice Address - Street 1:2930 INLAND EMPIRE BLVD
Practice Address - Street 2:SUITE 120
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-4802
Practice Address - Country:US
Practice Address - Phone:909-957-5564
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health