Provider Demographics
NPI:1902353618
Name:ALANIZ, ROSANA CORIA
Entity type:Individual
Prefix:
First Name:ROSANA
Middle Name:CORIA
Last Name:ALANIZ
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 1:135 E OLIVE AVE # 667
Mailing Address - Street 2:
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91502-1820
Mailing Address - Country:US
Mailing Address - Phone:818-338-2707
Mailing Address - Fax:818-304-9051
Practice Address - Street 1:135 E OLIVE AVE # 667
Practice Address - Street 2:
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91502-1820
Practice Address - Country:US
Practice Address - Phone:818-338-2707
Practice Address - Fax:818-304-9051
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-10
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA92772101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA#95-2633765OtherMEDI-CAL