Provider Demographics
NPI:1811574874
Name:CANTUBA, ROSALIE DIAZ (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:DIAZ
Last Name:CANTUBA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16453 BIRCHER ST
Mailing Address - Street 2:
Mailing Address - City:GRANADA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91344-2918
Mailing Address - Country:US
Mailing Address - Phone:818-849-9296
Mailing Address - Fax:
Practice Address - Street 1:16453 BIRCHER ST
Practice Address - Street 2:
Practice Address - City:GRANADA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91344-2918
Practice Address - Country:US
Practice Address - Phone:818-849-9296
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-25
Last Update Date:2021-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP95016537363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily