Provider Demographics
NPI:1689068801
Name:ROSARIO, GENEVIEVE (RN)
Entity Type:Individual
Prefix:
First Name:GENEVIEVE
Middle Name:
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15845 NIELSON AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LORENZO
Mailing Address - State:CA
Mailing Address - Zip Code:94580-1400
Mailing Address - Country:US
Mailing Address - Phone:510-433-1500
Mailing Address - Fax:510-663-6798
Practice Address - Street 1:510 17TH ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-1553
Practice Address - Country:US
Practice Address - Phone:510-433-1150
Practice Address - Fax:510-452-8836
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2015-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA333153171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA333153OtherRN LICENSE