Provider Demographics
NPI:1346128543
Name:ROSAS, MIA VANESSA-ROSE
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:VANESSA-ROSE
Last Name:ROSAS
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 1:5800 PYRACANTHA DR
Mailing Address - Street 2:
Mailing Address - City:SHINGLE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:95682-5149
Mailing Address - Country:US
Mailing Address - Phone:650-520-6837
Mailing Address - Fax:
Practice Address - Street 1:1825 PRAIRIE CITY RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-9578
Practice Address - Country:US
Practice Address - Phone:916-693-6351
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-25
Last Update Date:2025-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician