Provider Demographics
NPI:1306974001
Name:ROSAS, FANY PATRICIA
Entity type:Individual
Prefix:
First Name:FANY
Middle Name:PATRICIA
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 1:101 E VALENCIA MESA DR
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3809
Mailing Address - Country:US
Mailing Address - Phone:174-446-5100
Mailing Address - Fax:171-444-6072
Practice Address - Street 1:731 S. HIGHLAND AVE.
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832
Practice Address - Country:US
Practice Address - Phone:714-446-5100
Practice Address - Fax:714-446-0726
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2021-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF16081363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily