Provider Demographics
NPI:1821644865
Name:MACIAS, ROSENDA ARIAS (LICENSED VOCATIONAL)
Entity Type:Individual
Prefix:
First Name:ROSENDA
Middle Name:ARIAS
Last Name:MACIAS
Suffix:
Gender:F
Credentials:LICENSED VOCATIONAL
Other - Prefix:
Other - First Name:ROSENDA
Other - Middle Name:ARIAS
Other - Last Name:GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2001 28TH ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93301-1924
Mailing Address - Country:US
Mailing Address - Phone:661-391-3180
Mailing Address - Fax:
Practice Address - Street 1:2001 28TH ST
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93301-1924
Practice Address - Country:US
Practice Address - Phone:661-391-3180
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-15
Last Update Date:2019-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA689480164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse