Provider Demographics
NPI:1619692217
Name:ROSE, AUBRIANNE ALEXA
Entity Type:Individual
Prefix:
First Name:AUBRIANNE
Middle Name:ALEXA
Last Name:ROSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AUBRIANNE
Other - Middle Name:ALEXA
Other - Last Name:CHO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:27956 DEXTER DR
Mailing Address - Street 2:
Mailing Address - City:SANTA CLARITA
Mailing Address - State:CA
Mailing Address - Zip Code:91350-3652
Mailing Address - Country:US
Mailing Address - Phone:818-751-3246
Mailing Address - Fax:
Practice Address - Street 1:2525 HONOLULU AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CA
Practice Address - Zip Code:91020-1805
Practice Address - Country:US
Practice Address - Phone:818-484-8878
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95114077163W00000X
CA95022905363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse