Provider Demographics
NPI:1053026732
Name:KIRK, ROSA MARIA (CPT-1)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:MARIA
Last Name:KIRK
Suffix:
Gender:F
Credentials:CPT-1
Other - Prefix:MS
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:KIRK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8450 G AVE SPC 74
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6590
Mailing Address - Country:US
Mailing Address - Phone:760-669-4808
Mailing Address - Fax:
Practice Address - Street 1:8450 G AVE SPC 74
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6590
Practice Address - Country:US
Practice Address - Phone:760-669-4808
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-18
Last Update Date:2023-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor