Provider Demographics
NPI:1255525465
Name:ROZAR, RANDY LEE (MFTI)
Entity type:Individual
Prefix:
First Name:RANDY
Middle Name:LEE
Last Name:ROZAR
Suffix:
Gender:M
Credentials:MFTI
Other - Prefix:
Other - First Name:RAND
Other - Middle Name:LEE
Other - Last Name:ROZAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MFTI
Mailing Address - Street 1:31681 RIVERSIDE DR
Mailing Address - Street 2:SUITE L
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92530-7815
Mailing Address - Country:US
Mailing Address - Phone:951-674-9243
Mailing Address - Fax:951-674-9635
Practice Address - Street 1:31681 RIVERSIDE DR
Practice Address - Street 2:SUITE L
Practice Address - City:LAKE ELSINORE
Practice Address - State:CA
Practice Address - Zip Code:92530-7815
Practice Address - Country:US
Practice Address - Phone:951-674-9243
Practice Address - Fax:951-674-9635
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-30
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA49449106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist