Provider Demographics
NPI:1871938803
Name:MARILOU C. ROSAS BEHAVIORAL HEALTH, INC.
Entity type:Organization
Organization Name:MARILOU C. ROSAS BEHAVIORAL HEALTH, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MARILOU
Authorized Official - Middle Name:CANADA
Authorized Official - Last Name:ROSAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-506-9112
Mailing Address - Street 1:32605 TEMECULA PKWY
Mailing Address - Street 2:SUITE 219
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92592-6837
Mailing Address - Country:US
Mailing Address - Phone:951-506-9112
Mailing Address - Fax:951-506-9113
Practice Address - Street 1:32605 TEMECULA PKWY
Practice Address - Street 2:SUITE 219
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92592-6837
Practice Address - Country:US
Practice Address - Phone:951-506-9112
Practice Address - Fax:951-506-9113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-03
Last Update Date:2013-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA97944103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty