Provider Demographics
NPI:1144830035
Name:FISHER-MACK, ROSALIND
Entity type:Individual
Prefix:
First Name:ROSALIND
Middle Name:
Last Name:FISHER-MACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5149 GLEASON DR STE D115
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-7627
Mailing Address - Country:US
Mailing Address - Phone:925-551-6898
Mailing Address - Fax:
Practice Address - Street 1:5149 GLEASON DR STE D115
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-7627
Practice Address - Country:US
Practice Address - Phone:925-551-6898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator