Provider Demographics
NPI:1245844265
Name:HATCHKHAN, ROSIE
Entity type:Individual
Prefix:MRS
First Name:ROSIE
Middle Name:
Last Name:HATCHKHAN
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 1:684 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-1940
Mailing Address - Country:US
Mailing Address - Phone:909-522-9297
Mailing Address - Fax:
Practice Address - Street 1:23820 IRONWOOD AVE SPC 194
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92557-8137
Practice Address - Country:US
Practice Address - Phone:951-221-1378
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide