Basic Information
| Provider Information | |||||||||
| NPI: | 1710506001 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HA | ||||||||
| FirstName: | ROSALYN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2813 E BROAD ST APT B | ||||||||
| Address2: | |||||||||
| City: | RICHMOND | ||||||||
| State: | VA | ||||||||
| PostalCode: | 232237477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4043865384 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9245 RAINIER AVE S FL 1 | ||||||||
| Address2: | |||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981185569 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2064616981 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2020 | ||||||||
| LastUpdateDate: | 04/16/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 04/16/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.