Provider Demographics
NPI:1730925330
Name:ASSEFA, ROZA
Entity type:Individual
Prefix:
First Name:ROZA
Middle Name:
Last Name:ASSEFA
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 1:14634 SE NATALYA ST
Mailing Address - Street 2:
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-4206
Mailing Address - Country:US
Mailing Address - Phone:310-921-0877
Mailing Address - Fax:503-454-0034
Practice Address - Street 1:14634 SE NATALYA ST
Practice Address - Street 2:
Practice Address - City:HAPPY VALLEY
Practice Address - State:OR
Practice Address - Zip Code:97086-4206
Practice Address - Country:US
Practice Address - Phone:310-921-0877
Practice Address - Fax:503-454-0034
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR529336253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253J00000XAgenciesFoster Care Agency