Coral Roseberry, DNP, FNP, AGNP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

95026375 Issued in CA

Practice address

8851 Center Dr Ste 408
La Mesa, CA 91942-3076

Phone

(619) 583-1174

NPI assigned

Jul 26, 2023

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Majid Shahbaz MD Inc

  • Geriatric Medicine (Internal Medicine) Physician
  • San Diego, CA
  • NPI 1295839934
  Medicare reassignment NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1690329600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692748800000",
    "number": "1255012860",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9395 HARRITT RD SPC 111",
            "city": "LAKESIDE",
            "state": "CA",
            "postal_code": "920403530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8851 CENTER DR STE 408",
            "city": "LA MESA",
            "state": "CA",
            "postal_code": "919423076",
            "telephone_number": "619-583-1174"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROSEBERRY",
        "first_name": "CORAL",
        "name_prefix": "Dr.",
        "credential": "DNP, FNP, AGNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-07-26",
        "last_updated": "2023-08-23",
        "certification_date": "2023-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "RN95169759",
            "primary": false
        },
        {
            "code": "363LG0600X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Gerontology",
            "state": "CA",
            "license": "95026375",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "95026375",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Root and Soul, Inc
• Stephanie J Root, N.P.
• Roots & Wings Individual and Family Counseling Associates Inc
• Brittney Nicole Rosas-Davis
• Kellyanne Rose
• Jessica Rosete
• Alejandra Hassouni Ross
• Gena Ross
• Sterling Charles Ross
• Sara Susanne Rourke, M.D.

• Family Nurse Practitioner in La Mesa, CA
• Providers in La Mesa, CA by specialty
• Family Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.