Individual
MARY THERESA ROSE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1965 LIVE OAK BLVD, YUBA CITY, CA 95991-8850
(530) 822-7209
Mailing address
1965 LIVE OAK BLVD, YUBA CITY, CA 95991-8850
(530) 822-7209
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
34407
CA
167G00000X
Licensed Psychiatric Technician
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Other
Enumeration date
06/20/2021
Last updated
06/20/2021
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