Provider Demographics
NPI:1699003756
Name:ROSE MAESTAS
Entity Type:Organization
Organization Name:ROSE MAESTAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:MAESTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-805-0701
Mailing Address - Street 1:1527 19TH ST STE 402
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-4440
Mailing Address - Country:US
Mailing Address - Phone:661-805-0701
Mailing Address - Fax:
Practice Address - Street 1:1527 19TH ST STE 402
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-4440
Practice Address - Country:US
Practice Address - Phone:661-805-0701
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-01
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0570058246XS1301X, 2471V0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246XS1301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist CardiovascularSonographyGroup - Multi-Specialty
No2471V0105XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistVascular SonographyGroup - Multi-Specialty