Provider Demographics
NPI:1326874991
Name:OGANESIAN, ROSIE
Entity type:Individual
Prefix:
First Name:ROSIE
Middle Name:
Last Name:OGANESIAN
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 1:7900 MATILIJA AVE
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-6125
Mailing Address - Country:US
Mailing Address - Phone:323-491-9001
Mailing Address - Fax:
Practice Address - Street 1:14675 TIGERTAIL RD
Practice Address - Street 2:
Practice Address - City:APPLE VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92307-5246
Practice Address - Country:US
Practice Address - Phone:323-491-9001
Practice Address - Fax:888-668-0999
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-11
Last Update Date:2024-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA365530286310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility