Provider Demographics
NPI:1861073090
Name:YOUSEFIAN, ROSE ROZA
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:ROZA
Last Name:YOUSEFIAN
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 1:1199 DELBON AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-2006
Mailing Address - Country:US
Mailing Address - Phone:818-509-4213
Mailing Address - Fax:
Practice Address - Street 1:1199 DELBON AVE STE 6
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-2006
Practice Address - Country:US
Practice Address - Phone:818-509-4213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA315D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315D00000XNursing & Custodial Care FacilitiesHospice, Inpatient