Provider Demographics
NPI:1982264966
Name:ROSA LEE ACEVEDO PH.D. APC
Entity Type:Organization
Organization Name:ROSA LEE ACEVEDO PH.D. APC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:ACEVEDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-369-5211
Mailing Address - Street 1:3593 ARLINGTON AVE STE J
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3935
Mailing Address - Country:US
Mailing Address - Phone:951-369-5211
Mailing Address - Fax:951-276-0482
Practice Address - Street 1:3593 ARLINGTON AVE STE J
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3935
Practice Address - Country:US
Practice Address - Phone:951-369-5211
Practice Address - Fax:951-276-0482
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty