Provider Demographics
NPI:1740689322
Name:ROSSMAN, IRENE VIKTORIA
Entity type:Individual
Prefix:
First Name:IRENE
Middle Name:VIKTORIA
Last Name:ROSSMAN
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 1:105 HOLLYWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94591-7925
Mailing Address - Country:US
Mailing Address - Phone:415-793-0811
Mailing Address - Fax:
Practice Address - Street 1:105 HOLLYWOOD AVE
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94591-7925
Practice Address - Country:US
Practice Address - Phone:415-793-0811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-19
Last Update Date:2014-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program