Provider Demographics
NPI:1912255175
Name:ROBERTSON, ROSEMARY C (MASSAGE, HHP)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MASSAGE, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3960 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-3570
Mailing Address - Country:US
Mailing Address - Phone:619-218-2239
Mailing Address - Fax:
Practice Address - Street 1:3960 PARK BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-3570
Practice Address - Country:US
Practice Address - Phone:619-218-2239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-20
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA593609173C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173C00000XOther Service ProvidersReflexologist