Provider Demographics
NPI:1760819494
Name:ROSAS, NANCY LORENA
Entity Type:Individual
Prefix:MRS
First Name:NANCY
Middle Name:LORENA
Last Name:ROSAS
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 1:13043 FOOTHILL BLVD
Mailing Address - Street 2:SUITE #11
Mailing Address - City:SYLMAR
Mailing Address - State:CA
Mailing Address - Zip Code:91342-4931
Mailing Address - Country:US
Mailing Address - Phone:818-723-5808
Mailing Address - Fax:
Practice Address - Street 1:13043 FOOTHILL BLVD
Practice Address - Street 2:SUITE #11
Practice Address - City:SYLMAR
Practice Address - State:CA
Practice Address - Zip Code:91342-4931
Practice Address - Country:US
Practice Address - Phone:818-755-8786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-26
Last Update Date:2019-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95996106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist