Provider Demographics
NPI:1164558771
Name:ROSALES, SANTIAGO JR (CO)
Entity Type:Individual
Prefix:
First Name:SANTIAGO
Middle Name:
Last Name:ROSALES
Suffix:JR
Gender:M
Credentials:CO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1355 BESSIE AVE
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-3415
Mailing Address - Country:US
Mailing Address - Phone:209-834-8600
Mailing Address - Fax:209-834-8700
Practice Address - Street 1:1355 BESSIE AVE
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95376-3415
Practice Address - Country:US
Practice Address - Phone:209-834-8600
Practice Address - Fax:209-834-8700
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist