Provider Demographics
NPI:1316469018
Name:ROSTRO, SUSANA IVETTE (LVN)
Entity type:Individual
Prefix:
First Name:SUSANA
Middle Name:IVETTE
Last Name:ROSTRO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:SUSANA
Other - Middle Name:IVETTE
Other - Last Name:SERRATO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1261 E 3RD ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90802-3602
Mailing Address - Country:US
Mailing Address - Phone:562-233-7296
Mailing Address - Fax:
Practice Address - Street 1:1261 E 3RD ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90802-3602
Practice Address - Country:US
Practice Address - Phone:562-233-7296
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-13
Last Update Date:2017-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN264156164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse