Provider Demographics
NPI:1982701678
Name:STASAITIS, ROSA M (CPNP)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:M
Last Name:STASAITIS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:936 PINE AVE
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90813-4326
Mailing Address - Country:US
Mailing Address - Phone:562-491-9292
Mailing Address - Fax:562-495-1878
Practice Address - Street 1:936 PINE AVE
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-4326
Practice Address - Country:US
Practice Address - Phone:562-491-9292
Practice Address - Fax:562-495-1878
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395672363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics