Provider Demographics
NPI:1306310925
Name:ROSAS RODRIGUEZ, NANCY RUBI (CDPT)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:RUBI
Last Name:ROSAS RODRIGUEZ
Suffix:
Gender:F
Credentials:CDPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5915 ORCHARD ST W.
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98467
Mailing Address - Country:US
Mailing Address - Phone:253-414-7461
Mailing Address - Fax:253-627-8387
Practice Address - Street 1:5915 ORCHARD ST W.
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98467
Practice Address - Country:US
Practice Address - Phone:253-414-7461
Practice Address - Fax:253-627-8387
Is Sole Proprietor?:No
Enumeration Date:2019-01-16
Last Update Date:2019-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAC060778215101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)