Provider Demographics
NPI:1851933188
Name:RASCON, ROZANNE NICOLE (RN, PHN)
Entity Type:Individual
Prefix:
First Name:ROZANNE
Middle Name:NICOLE
Last Name:RASCON
Suffix:
Gender:F
Credentials:RN, PHN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:765 W 26TH ST UNIT 304
Mailing Address - Street 2:
Mailing Address - City:SAN PEDRO
Mailing Address - State:CA
Mailing Address - Zip Code:90731-6348
Mailing Address - Country:US
Mailing Address - Phone:559-355-3899
Mailing Address - Fax:
Practice Address - Street 1:765 W 26TH ST UNIT 304
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90731-6348
Practice Address - Country:US
Practice Address - Phone:559-355-3899
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95144886163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA8325OtherPIN