Active NPI
Brandon Lee Rose, B.S. DEGREE
- Assisted Living Facility
- Stockton, CA
National Provider Identifier
1942606108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assisted Living Facility
- License
- 397002695
- Practice address
- 9207 Mammath Peak Cir
Stockton, CA 95212-3212 - Phone
- (209) 623-7456
- Fax
- (209) 594-1872
- NPI assigned
- Nov 14, 2014
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Assisted Living Facility | 310400000X | 397002695 | CA | Primary |
Addresses
Primary practice location
9207 Mammath Peak Cir
Stockton, CA 95212-3212
Mailing address
9207 Mammath Peak Cir
Stockton, CA 95212-3212
Phone (209) 623-7456
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
- Credentials
- Bachelor of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 397002695 | CA | MD | Assisted Living Facility |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1415923200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1415923200000",
"number": "1942606108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9207 MAMMATH PEAK CIR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952123212",
"telephone_number": "209-623-7456",
"fax_number": "209-594-1872"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9207 MAMMATH PEAK CIR",
"city": "STOCKTON",
"state": "CA",
"postal_code": "952123212",
"telephone_number": "209-623-7456",
"fax_number": "209-594-1872"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROSE",
"first_name": "BRANDON",
"middle_name": "LEE",
"name_prefix": "Mr.",
"credential": "B.S. DEGREE",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2014-11-14",
"last_updated": "2014-11-14",
"status": "A"
},
"taxonomies": [
{
"code": "310400000X",
"taxonomy_group": "",
"desc": "Assisted Living Facility",
"state": "CA",
"license": "397002695",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.