Provider Demographics
NPI:1073270286
Name:ROSETE, JONAS DEL RIO
Entity Type:Individual
Prefix:
First Name:JONAS
Middle Name:DEL RIO
Last Name:ROSETE
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 1:26611 LA QUILLA LN
Mailing Address - Street 2:
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92692-3926
Mailing Address - Country:US
Mailing Address - Phone:949-356-5732
Mailing Address - Fax:
Practice Address - Street 1:26611 LA QUILLA LN
Practice Address - Street 2:
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3926
Practice Address - Country:US
Practice Address - Phone:949-356-5732
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-22
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver
Provider Identifiers
StateIdentifier IDID TypeIssuer
NONEOtherNONE