Provider Demographics
NPI:1962736124
Name:ROSALES, ISABEL (COTA/L)
Entity type:Individual
Prefix:MRS
First Name:ISABEL
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:COTA/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2945 CALLE FRONTERA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92673-3007
Mailing Address - Country:US
Mailing Address - Phone:949-259-3777
Mailing Address - Fax:
Practice Address - Street 1:2945 CALLE FRONTERA
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92673-3007
Practice Address - Country:US
Practice Address - Phone:949-259-3777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-21
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOTA1137224Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational Therapy Assistant