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12383 Mays Canyon Rd Guerneville CA 95446-9499 | |
| (707) 604-1400 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Social Worker |
| Location | 12383 Mays Canyon Rd, Guerneville, California |
| Authorized Official Name and Position | Sean Rosas (OWNER) |
| Authorized Official Contact | 7076041400 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
12383 Mays Canyon Rd Guerneville CA 95446-9499 Ph: (707) 604-1400 | 12383 Mays Canyon Rd Guerneville CA 95446-9499 Ph: (707) 604-1400 |
| NPI Number | 1891518882 |
|---|---|
| Provider Enumeration Date | 11/06/2024 |
| Last Update Date | 11/15/2024 |
| Certification Date | 11/15/2024 |
| Medicare PECOS PAC ID | 7214461086 |
|---|---|
| Medicare Enrollment ID | O20241115001975 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1891518882 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Sean A Rosas |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1366004079 PECOS PAC ID: 2769916535 Enrollment ID: I20241119002929 |
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