Provider Demographics
NPI:1033319009
Name:YAOTONALCUAUHTLI-ORTA, ROSA TUPINA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:TUPINA
Last Name:YAOTONALCUAUHTLI-ORTA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:VALENZUELA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:904 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:CROCKETT
Mailing Address - State:CA
Mailing Address - Zip Code:94525-1319
Mailing Address - Country:US
Mailing Address - Phone:510-787-6937
Mailing Address - Fax:510-787-6937
Practice Address - Street 1:904 5TH AVE
Practice Address - Street 2:
Practice Address - City:CROCKETT
Practice Address - State:CA
Practice Address - Zip Code:94525-1319
Practice Address - Country:US
Practice Address - Phone:510-787-6937
Practice Address - Fax:510-787-6937
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-18
Last Update Date:2007-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS246871041C0700X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No251S00000XAgenciesCommunity/Behavioral Health