Provider Demographics
NPI:1760235493
Name:ROSE, TINGTING (DACM)
Entity Type:Individual
Prefix:DR
First Name:TINGTING
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:DACM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1181 SAN PABLO DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4814
Mailing Address - Country:US
Mailing Address - Phone:949-662-8686
Mailing Address - Fax:
Practice Address - Street 1:1146 SAN MARINO DR
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4649
Practice Address - Country:US
Practice Address - Phone:760-896-1883
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-11
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20046171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist