Provider Demographics
NPI:1568181196
Name:VESSAL, ROSA SARA (OTR/L, IBCLC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:SARA
Last Name:VESSAL
Suffix:
Gender:F
Credentials:OTR/L, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13349 YUCATAN PL
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-8643
Mailing Address - Country:US
Mailing Address - Phone:858-209-9434
Mailing Address - Fax:
Practice Address - Street 1:7313 WHITTIER AVE
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-1132
Practice Address - Country:US
Practice Address - Phone:424-442-9129
Practice Address - Fax:310-943-3821
Is Sole Proprietor?:No
Enumeration Date:2022-08-25
Last Update Date:2022-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
305667174N00000X
CA21701225X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225X00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapist
No174N00000XOther Service ProvidersLactation Consultant, Non-RN