Individual
EMBER ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
2600 S EL CAMINO REAL STE 200, SAN MATEO, CA 94403-2382
(650) 373-0777
Mailing address
2600 S EL CAMINO REAL STE 200, SAN MATEO, CA 94403-2382
Taxonomy
Speciality
Code
Description
License number
State
163WP0808X
Psychiatric/Mental Health Registered Nurse
Primary
814713
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
814713
MEDI-CAL
CA
Enumeration date
09/13/2018
Last updated
09/13/2018
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