Provider Demographics
NPI:1114019015
Name:ROSE AVENUE FAMILY MEDICAL GROUP A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:ROSE AVENUE FAMILY MEDICAL GROUP A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPHINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SOLIZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-988-1443
Mailing Address - Street 1:451 W GONZALES RD STE 230
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-0726
Mailing Address - Country:US
Mailing Address - Phone:805-988-1443
Mailing Address - Fax:805-988-0897
Practice Address - Street 1:451 W GONZALES RD STE 230
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036
Practice Address - Country:US
Practice Address - Phone:805-988-1443
Practice Address - Fax:805-988-0897
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-28
Last Update Date:2018-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ38731ZOtherBLUE SHIELD GROUP NUMBER
CAGR0028670Medicaid
CAZZZ38731ZOtherBLUE SHIELD GROUP NUMBER