Provider Demographics
NPI:1669740544
Name:LARIOS, ROSA ISELA (MA)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:ISELA
Last Name:LARIOS
Suffix:
Gender:
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3060 PANORAMA RD APT 9
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-1400
Mailing Address - Country:US
Mailing Address - Phone:310-722-0574
Mailing Address - Fax:
Practice Address - Street 1:2450 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:COMMERCE
Practice Address - State:CA
Practice Address - Zip Code:90040-1200
Practice Address - Country:US
Practice Address - Phone:323-318-9960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-07
Last Update Date:2025-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66891106H00000X
CA106088106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist