Provider Demographics
NPI:1215786678
Name:ROSAS, STEPHANNIE ANAHI
Entity type:Individual
Prefix:
First Name:STEPHANNIE
Middle Name:ANAHI
Last Name:ROSAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N ANAHEIM BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801-1202
Mailing Address - Country:US
Mailing Address - Phone:657-242-4381
Mailing Address - Fax:714-687-9213
Practice Address - Street 1:1325 N ANAHEIM BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-1202
Practice Address - Country:US
Practice Address - Phone:657-242-4381
Practice Address - Fax:714-687-9213
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator