Provider Demographics
NPI:1003054511
Name:ROSALES, ANNA LISSA (PA-C)
Entity Type:Individual
Prefix:
First Name:ANNA LISSA
Middle Name:
Last Name:ROSALES
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNA LISSA
Other - Middle Name:R
Other - Last Name:MILLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:5810 EL CAMINO REAL STE A
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92008-8819
Mailing Address - Country:US
Mailing Address - Phone:760-929-8269
Mailing Address - Fax:
Practice Address - Street 1:5810 EL CAMINO REAL STE A
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-8819
Practice Address - Country:US
Practice Address - Phone:760-929-8269
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-22
Last Update Date:2021-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA22269OtherPA LICENSE NUMBER