Provider Demographics
NPI:1174859136
Name:ROSALITA LLC
Entity Type:Organization
Organization Name:ROSALITA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF ORIENTAL MEDICINE
Authorized Official - Prefix:DR
Authorized Official - First Name:FERAL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MACLOUD
Authorized Official - Suffix:
Authorized Official - Credentials:DOM
Authorized Official - Phone:505-204-1239
Mailing Address - Street 1:518 OLD SANTA FE TRL # 171
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0398
Mailing Address - Country:US
Mailing Address - Phone:505-204-1239
Mailing Address - Fax:
Practice Address - Street 1:518 OLD SANTA FE TRL # 171
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-0398
Practice Address - Country:US
Practice Address - Phone:505-204-1239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-27
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM502261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health