Provider Demographics
NPI:1902166366
Name:ROSALES, DRUSILLA MARIA (MS, RD)
Entity type:Individual
Prefix:MRS
First Name:DRUSILLA
Middle Name:MARIA
Last Name:ROSALES
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13312 FOXLEY DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3506
Mailing Address - Country:US
Mailing Address - Phone:562-309-3396
Mailing Address - Fax:
Practice Address - Street 1:418 S BREA BLVD
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5301
Practice Address - Country:US
Practice Address - Phone:562-309-3396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-20
Last Update Date:2012-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1040062133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered