Provider Demographics
NPI:1346663069
Name:FOX, ROSALYN (NP)
Entity type:Individual
Prefix:MS
First Name:ROSALYN
Middle Name:
Last Name:FOX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39350 CIVIC CENTER DR
Mailing Address - Street 2:SUITE 260
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-2343
Mailing Address - Country:US
Mailing Address - Phone:501-931-4310
Mailing Address - Fax:
Practice Address - Street 1:39350 CIVIC CENTER DR
Practice Address - Street 2:SUITE 260
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-2343
Practice Address - Country:US
Practice Address - Phone:510-931-4310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-31
Last Update Date:2014-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000192363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily