Provider Demographics
NPI:1801329115
Name:BARRERAS, ROSALIE TAC-AN (LICENSE NURSE)
Entity type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:TAC-AN
Last Name:BARRERAS
Suffix:
Gender:F
Credentials:LICENSE NURSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5960 RILEY ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92110-1420
Mailing Address - Country:US
Mailing Address - Phone:619-850-5051
Mailing Address - Fax:
Practice Address - Street 1:5960 RILEY ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92110-1420
Practice Address - Country:US
Practice Address - Phone:619-708-0495
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-04
Last Update Date:2019-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN234466164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse