Provider Demographics
NPI:1912737107
Name:ENDICK, ROSEMARY LAURA
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:LAURA
Last Name:ENDICK
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 1:2040 LOTUS WAY
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-6726
Mailing Address - Country:US
Mailing Address - Phone:925-864-8120
Mailing Address - Fax:
Practice Address - Street 1:2040 LOTUS WAY
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-6726
Practice Address - Country:US
Practice Address - Phone:925-864-8120
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-03
Last Update Date:2024-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities