Provider Demographics
NPI:1861093783
Name:BARRETTO, ROSSANA R (LPN)
Entity type:Individual
Prefix:
First Name:ROSSANA
Middle Name:R
Last Name:BARRETTO
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16948 W MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-7428
Mailing Address - Country:US
Mailing Address - Phone:623-336-0262
Mailing Address - Fax:623-594-8895
Practice Address - Street 1:16948 W MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-7428
Practice Address - Country:US
Practice Address - Phone:623-336-0262
Practice Address - Fax:623-594-8895
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAL11534H311ZA0620X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home