Provider Demographics
NPI:1790235471
Name:DESROSIERS, JOSETTE CARMEN
Entity Type:Individual
Prefix:
First Name:JOSETTE
Middle Name:CARMEN
Last Name:DESROSIERS
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 1:12759 POWAY RD
Mailing Address - Street 2:#101
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-4437
Mailing Address - Country:US
Mailing Address - Phone:858-231-1837
Mailing Address - Fax:
Practice Address - Street 1:12759 POWAY RD
Practice Address - Street 2:#101
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4437
Practice Address - Country:US
Practice Address - Phone:858-231-1837
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-06
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management