Individual
DR. JONATHON M ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
327 N SAN MATEO DR, SUITE 3, SAN MATEO, CA 94401-2543
(650) 703-4769
Mailing address
411 HILLCREST RD, SAN CARLOS, CA 94070-1918
(650) 703-4769
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY12143
CA
103T00000X
Psychologist
PSY12143
CA
103TA0700X
Adult Development & Aging Psychologist
Primary
PSY12143
CA
103TC0700X
Clinical Psychologist
PSY12143
CA
103TF0200X
Forensic Psychologist
PSY12143
CA
103TH0100X
Health Service Psychologist
PSY12143
CA
103TR0400X
Rehabilitation Psychologist
PSY12143
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PSY121430
—
CA
Enumeration date
03/29/2006
Last updated
07/29/2010
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