Basic Information
| Provider Information | |||||||||
| NPI: | 1669740544 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LARIOS | ||||||||
| FirstName: | ROSA | ||||||||
| MiddleName: | ISELA | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | M.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3060 PANORAMA RD APT 9 | ||||||||
| Address2: | |||||||||
| City: | RIVERSIDE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 925061400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107220574 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2450 S ATLANTIC BLVD | ||||||||
| Address2: | SUITE 101 | ||||||||
| City: | COMMERCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900401200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3233189960 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/07/2011 | ||||||||
| LastUpdateDate: | 07/29/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | 66891 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 106088 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.