Provider Demographics
NPI:1447625801
Name:GUIHAMA, ROSEBERRY
Entity type:Individual
Prefix:
First Name:ROSEBERRY
Middle Name:
Last Name:GUIHAMA
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 1:11618 SOUTH ST UNIT 201
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-6618
Mailing Address - Country:US
Mailing Address - Phone:562-865-3355
Mailing Address - Fax:562-865-5599
Practice Address - Street 1:11618 SOUTH ST UNIT 201
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-6618
Practice Address - Country:US
Practice Address - Phone:562-865-3355
Practice Address - Fax:562-865-5599
Is Sole Proprietor?:No
Enumeration Date:2015-12-09
Last Update Date:2015-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11144225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11144OtherPHYSICAL THERAPY BOARD OF CALIFORNIA