Provider Demographics
NPI:1669896551
Name:CALLENDER, ROSE (FNP-BC)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:CALLENDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 OCEANGATE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-4317
Mailing Address - Country:US
Mailing Address - Phone:562-499-6191
Mailing Address - Fax:877-778-9467
Practice Address - Street 1:790 E. FOOTHILL BLVD.
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-5269
Practice Address - Country:US
Practice Address - Phone:909-546-7135
Practice Address - Fax:877-778-9467
Is Sole Proprietor?:No
Enumeration Date:2014-02-12
Last Update Date:2016-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA842294163W00000X
CA95000207363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAEFFECTIVE 4/9/15Medicaid
CACA163940-GA222AMedicare PIN
CAEFFECTIVE 4/9/15Medicaid