Provider Demographics
NPI:1043930290
Name:ROSEBAR, JUAN
Entity Type:Individual
Prefix:
First Name:JUAN
Middle Name:
Last Name:ROSEBAR
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3001 BLADENSBURG RD NE APT 919
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-2238
Mailing Address - Country:US
Mailing Address - Phone:202-766-8825
Mailing Address - Fax:
Practice Address - Street 1:3001 BLADENSBURG RD NE APT 919
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2238
Practice Address - Country:US
Practice Address - Phone:202-776-8825
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC4171415Medicaid