Provider Demographics
NPI:1780464701
Name:ROSALES-VALLEJO, ERICA
Entity type:Individual
Prefix:
First Name:ERICA
Middle Name:
Last Name:ROSALES-VALLEJO
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 1:38401 N POINTE DR UNIT 115T
Mailing Address - Street 2:
Mailing Address - City:HARRISON TWP
Mailing Address - State:MI
Mailing Address - Zip Code:48045-6836
Mailing Address - Country:US
Mailing Address - Phone:989-443-1728
Mailing Address - Fax:
Practice Address - Street 1:38401 N POINTE DR UNIT 115T
Practice Address - Street 2:
Practice Address - City:HARRISON TWP
Practice Address - State:MI
Practice Address - Zip Code:48045-6836
Practice Address - Country:US
Practice Address - Phone:989-443-1728
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-05
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMI000031335376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide