Individual provider Active NPI

Maritza Saucedo Rosas, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Santa Rosa, CA
National Provider Identifier
1437768082
Registry record updated Dec 5, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
95018455 Issued in CA
Practice address
2235 Challenger Way Ste 101
Santa Rosa, CA 95407-5421
Phone
(707) 565-4900
NPI assigned
Jul 29, 2020
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 5, 2022

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

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Registered Nurse 163W00000X 95202174 CA
Student in an Organized Health Care Education/Training Program 390200000X
Psychiatric/Mental Health Nurse Practitioner 363LP0808X 95018455 CA Primary

Addresses

Primary practice location

2235 Challenger Way Ste 101
Santa Rosa, CA 95407-5421

Mailing address

1129 Gumwood LN
Petaluma, CA 94954-4330
Phone (415) 497-3501

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20250211000054 CA Practitioner - Nurse Practitioner 0042740706 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
County of SonomaGroup PAC ID 4688658651, 28 clinicians

Practice addresses (Care Compare)

140 S Cloverdale Blvd
Cloverdale, CA 95425-3710
Phone (707) 565-4861

2225 Challenger Way
Santa Rosa, CA 95407-5441
Phone (707) 565-4861

810 Grove St
Sonoma, CA 95476-5328
Phone (707) 565-4861

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
County of Sonoma CurrentSince Dec 16, 2024 Accepting new patients
County of Sonoma CurrentSince Dec 16, 2024 Accepting new patients
County of Sonoma Current Accepting new patients

Locations

2235 Challenger Way
Ste 101
Santa Rosa, CA 95407
Phone (707) 565-4900

2225 Challenger Way
Santa Rosa, CA 95407
Phone (707) 565-4101

1450 Neotomas Ave
Ste 200
Santa Rosa, CA 95405
Phone (707) 565-4131

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1595980800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1670198400000",
    "number": "1437768082",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1129 GUMWOOD LN",
            "city": "PETALUMA",
            "state": "CA",
            "postal_code": "949544330",
            "telephone_number": "415-497-3501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2235 CHALLENGER WAY STE 101",
            "city": "SANTA ROSA",
            "state": "CA",
            "postal_code": "954075421",
            "telephone_number": "707-565-4900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SAUCEDO ROSAS",
        "first_name": "MARITZA",
        "name_prefix": "Ms.",
        "credential": "PMHNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-29",
        "last_updated": "2022-12-05",
        "certification_date": "2022-12-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "CA",
            "license": "95202174",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "CA",
            "license": "95018455",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Rosa, CA

Sources for this page

Verify at the official NPI Registry.