Provider Demographics
NPI:1972851194
Name:VANG, ROSE P (BS)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:P
Last Name:VANG
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:PAHOUA
Other - Middle Name:
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BS
Mailing Address - Street 1:4879 E KINGS CANYON RD
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93727-3811
Mailing Address - Country:US
Mailing Address - Phone:559-255-8395
Mailing Address - Fax:559-452-8062
Practice Address - Street 1:4879 E KINGS CANYON RD
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93727-3811
Practice Address - Country:US
Practice Address - Phone:559-255-8395
Practice Address - Fax:559-452-8062
Is Sole Proprietor?:No
Enumeration Date:2012-08-20
Last Update Date:2016-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health