Provider Demographics
NPI:1669667820
Name:ROSAS, RIGOBERTO (MFT INTERN)
Entity Type:Individual
Prefix:
First Name:RIGOBERTO
Middle Name:
Last Name:ROSAS
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 W CAMPBELL AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-1526
Mailing Address - Country:US
Mailing Address - Phone:408-871-4900
Mailing Address - Fax:408-871-4971
Practice Address - Street 1:1600 W CAMPBELL AVE STE 201
Practice Address - Street 2:
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-1526
Practice Address - Country:US
Practice Address - Phone:408-871-4900
Practice Address - Fax:408-871-4904
Is Sole Proprietor?:No
Enumeration Date:2007-09-11
Last Update Date:2021-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAIMF90241106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1063OtherFQHC MEDICARE PART A
CAZZZ29799ZOtherFQHC MEDICARE PART B