Provider Demographics
NPI:1225011729
Name:EASTON, ROSALIE J (PH D)
Entity type:Individual
Prefix:DR
First Name:ROSALIE
Middle Name:J
Last Name:EASTON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:591 CAMINO DE LAREINA
Mailing Address - Street 2:SUITE 918
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108
Mailing Address - Country:US
Mailing Address - Phone:619-294-9177
Mailing Address - Fax:619-294-8190
Practice Address - Street 1:591 CAMINO DE LAREINA
Practice Address - Street 2:SUITE 918
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108
Practice Address - Country:US
Practice Address - Phone:619-294-9177
Practice Address - Fax:619-294-8190
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-29
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13168103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY131680Medicaid
CAPSY131681Medicaid
CA5308368OtherAETNA
CP13168BMedicare ID - Type Unspecified
CAPSY131680Medicaid
CAPSY131681Medicaid