Provider Demographics
NPI:1245731678
Name:PATATANIAN, ROSETA
Entity type:Individual
Prefix:
First Name:ROSETA
Middle Name:
Last Name:PATATANIAN
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 114
Mailing Address - Street 2:
Mailing Address - City:SUN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91353-0114
Mailing Address - Country:US
Mailing Address - Phone:626-838-2608
Mailing Address - Fax:
Practice Address - Street 1:44750 60TH ST W
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93536-7619
Practice Address - Country:US
Practice Address - Phone:626-838-2608
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-21
Last Update Date:2025-03-21
Deactivation Date:2024-10-16
Deactivation Code:
Reactivation Date:2024-11-18
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
CAPSY35326103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst