Provider Demographics
NPI:1841304946
Name:ROSE, PATRICIA J (PHD)
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:J
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7911 HERSCHEL AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-0075
Mailing Address - Country:US
Mailing Address - Phone:858-454-5423
Mailing Address - Fax:858-459-5355
Practice Address - Street 1:7911 HERSCHEL AVE
Practice Address - Street 2:SUITE 400
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-0075
Practice Address - Country:US
Practice Address - Phone:858-454-5423
Practice Address - Fax:858-459-5355
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACP8591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAR32104Medicare UPIN
CACP8591Medicare ID - Type Unspecified