Provider Demographics
NPI:1881032324
Name:ROSALES, KISHA (RAS)
Entity type:Individual
Prefix:
First Name:KISHA
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 POGGI ST APT 204A
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-1870
Mailing Address - Country:US
Mailing Address - Phone:510-227-0010
Mailing Address - Fax:
Practice Address - Street 1:1825 POGGI ST APT 204A
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-1870
Practice Address - Country:US
Practice Address - Phone:510-227-0010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2013-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAR0808181531101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)