Provider Demographics
NPI:1194456442
Name:ROSSINI, MICHAEL THEODORE EDWARD III (BSN, RN, PHN, NREMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:THEODORE EDWARD
Last Name:ROSSINI
Suffix:III
Gender:M
Credentials:BSN, RN, PHN, NREMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 NEVIL ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-3820
Mailing Address - Country:US
Mailing Address - Phone:510-417-6162
Mailing Address - Fax:
Practice Address - Street 1:3700 NEVIL ST
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-3820
Practice Address - Country:US
Practice Address - Phone:510-417-6162
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-17
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE103783146N00000X
CA95199968163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic