Provider Demographics
NPI:1992512669
Name:GAZO ROSARIO, KATRINA SNOW (SUDRC)
Entity type:Individual
Prefix:MRS
First Name:KATRINA
Middle Name:SNOW
Last Name:GAZO ROSARIO
Suffix:
Gender:F
Credentials:SUDRC
Other - Prefix:
Other - First Name:KATRINA
Other - Middle Name:SNOW
Other - Last Name:ARCIERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:519 ELLIS ST APT 302
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-8158
Mailing Address - Country:US
Mailing Address - Phone:415-375-1111
Mailing Address - Fax:
Practice Address - Street 1:1563 MISSION ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94103-2543
Practice Address - Country:US
Practice Address - Phone:415-762-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-16
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CA20119101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No171M00000XOther Service ProvidersCase Manager/Care Coordinator