Provider Demographics
NPI:1750717211
Name:ROSARIO, MARILES CEZAR (NP)
Entity type:Individual
Prefix:MS
First Name:MARILES
Middle Name:CEZAR
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1663 BEVERLY BLVD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90026-5747
Mailing Address - Country:US
Mailing Address - Phone:213-250-0235
Mailing Address - Fax:213-250-0439
Practice Address - Street 1:1663 BEVERLY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5747
Practice Address - Country:US
Practice Address - Phone:213-250-0235
Practice Address - Fax:213-250-0439
Is Sole Proprietor?:No
Enumeration Date:2013-09-16
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF 22883363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily