Provider Demographics
NPI:1245960228
Name:ROSE, ROSCHEL XENIA (LVN)
Entity type:Individual
Prefix:
First Name:ROSCHEL
Middle Name:XENIA
Last Name:ROSE
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:ROSCHEL
Other - Middle Name:XENIA
Other - Last Name:IVERY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2000 CROFTON ST SPC 28
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-3557
Mailing Address - Country:US
Mailing Address - Phone:619-228-1523
Mailing Address - Fax:
Practice Address - Street 1:4309 THIRD AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103
Practice Address - Country:US
Practice Address - Phone:619-876-4502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-13
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA706083164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse