Provider Demographics
NPI:1790193472
Name:ROSETTE ADEGBE
Entity Type:Organization
Organization Name:ROSETTE ADEGBE
Other - Org Name:ROSETTE ADEGBE
Other - Org Type:Other Name
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:ROSETTE
Authorized Official - Middle Name:JONATHAN
Authorized Official - Last Name:ADEGBE
Authorized Official - Suffix:
Authorized Official - Credentials:NP-C
Authorized Official - Phone:323-806-5783
Mailing Address - Street 1:1084 FLAGER RANCH RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92881-4730
Mailing Address - Country:US
Mailing Address - Phone:951-549-6912
Mailing Address - Fax:951-817-9041
Practice Address - Street 1:1084 FLAGER RANCH RD
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92881-4730
Practice Address - Country:US
Practice Address - Phone:951-549-6912
Practice Address - Fax:951-817-9041
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NONE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-26
Last Update Date:2014-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF0714839261QA0600X, 273Y00000X, 311ZA0620X
261QE0002X, 363LF0000X
CAF0714829302R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No273Y00000XHospital UnitsRehabilitation Unit
No302R00000XManaged Care OrganizationsHealth Maintenance Organization
No311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care HomeGroup - Single Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty