Active NPI
Raven Nalika Rose, LMFT
- Marriage & Family Therapist
- Ontario, CA
National Provider Identifier
1205590767
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- 126047
- Practice address
- 3200 E Guasti Rd
Ontario, CA 91761-8660 - Phone
- (909) 295-5805
- NPI assigned
- Oct 29, 2021
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | 126047 | CA | Primary |
Addresses
Primary practice location
3200 E Guasti Rd
Ontario, CA 91761-8660
Mailing address
773 Center Blvd Unit 581
Fairfax, CA 94978-5710
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 126047 | CA | MD | Marriage & Family Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1635465600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727308800000",
"number": "1205590767",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "773 CENTER BLVD UNIT 581",
"city": "FAIRFAX",
"state": "CA",
"postal_code": "949785710"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3200 E GUASTI RD",
"city": "ONTARIO",
"state": "CA",
"postal_code": "917618660",
"telephone_number": "909-295-5805"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "RAVEN",
"middle_name": "NALIKA",
"credential": "LMFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-10-29",
"last_updated": "2024-09-26",
"certification_date": "2024-09-26",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "126047",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ontario, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 26, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.