Provider Demographics
NPI:1336266592
Name:ONTIVEROS, ROSA MARITZA
Entity Type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARITZA
Last Name:ONTIVEROS
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 1:1001 MANTELLI DR
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-7530
Mailing Address - Country:US
Mailing Address - Phone:408-612-5958
Mailing Address - Fax:
Practice Address - Street 1:6980 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-6635
Practice Address - Country:US
Practice Address - Phone:408-846-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health