Provider Demographics
NPI:1427160670
Name:ROSA, ELVIRA SILVIA (MS)
Entity type:Individual
Prefix:MS
First Name:ELVIRA
Middle Name:SILVIA
Last Name:ROSA
Suffix:
Gender:F
Credentials:MS
Other - Prefix:MS
Other - First Name:ELVIRA
Other - Middle Name:SILVIA
Other - Last Name:VALLADARES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 876
Mailing Address - Street 2:
Mailing Address - City:ARBUCKLE
Mailing Address - State:CA
Mailing Address - Zip Code:95912-0876
Mailing Address - Country:US
Mailing Address - Phone:916-613-2224
Mailing Address - Fax:
Practice Address - Street 1:4730 47TH AVE STE 300
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-3946
Practice Address - Country:US
Practice Address - Phone:916-391-6694
Practice Address - Fax:916-391-6726
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 49549106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist