Provider Demographics
NPI:1659941540
Name:DURRUTHY, ROSALYN MARGARITA
Entity Type:Individual
Prefix:
First Name:ROSALYN
Middle Name:MARGARITA
Last Name:DURRUTHY
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 1:330 MOSS ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2005
Mailing Address - Country:US
Mailing Address - Phone:619-426-6310
Mailing Address - Fax:
Practice Address - Street 1:330 MOSS ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2005
Practice Address - Country:US
Practice Address - Phone:619-426-6310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-01
Last Update Date:2021-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82729101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health