Provider Demographics
NPI:1184755944
Name:URIBE, ROSA VALENTINA
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:VALENTINA
Last Name:URIBE
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 1:516 S BRAND BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FERNANDO
Mailing Address - State:CA
Mailing Address - Zip Code:91340-4002
Mailing Address - Country:US
Mailing Address - Phone:818-361-5183
Mailing Address - Fax:
Practice Address - Street 1:11565 LAUREL CANYON BLVD
Practice Address - Street 2:#114
Practice Address - City:SAN FERNANDO
Practice Address - State:CA
Practice Address - Zip Code:91340-4168
Practice Address - Country:US
Practice Address - Phone:818-361-5030
Practice Address - Fax:818-365-7707
Is Sole Proprietor?:No
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner