Doctor Name: | MR. BRANDON LEE ROSE |
NPI Number: | 1942606108 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | B.S. DEGREE |
License Number: | 397002695 |
Business Practice Address: | 9207 Mammath Peak Cir Stockton, CA - 952123212 |
Business Phone Number: | 2096237456 |
Business Fax Number: | 2095941872 |
Mailing Address: | 9207 Mammath Peak Cir, STOCKTON |
State: | CA |
Postal Code: | 952123212 |
Phone Number: | 2096237456 |
Fax Number: | 2095941872 |
NPI Enumeration Date: | 11/14/2014 |
NPI Last Update Date: | 11/14/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 310400000X |
License Number: | 397002695 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Nursing & Custodial Care Facilities |
Taxonomy Classification: | Assisted Living Facility |
Taxonomy Specialization: | |
Taxonomy Definition: | A facility providing supportive services to individuals who can function independently in most areas of activity, but need assistance and/or monitoring to assure safety and well being. |