Provider Demographics
NPI:1245399740
Name:ROSANIO, SALVATORE (MD)
Entity Type:Individual
Prefix:
First Name:SALVATORE
Middle Name:
Last Name:ROSANIO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-0899
Mailing Address - Country:US
Mailing Address - Phone:409-256-6862
Mailing Address - Fax:949-545-7765
Practice Address - Street 1:27555 YNEZ RD STE 400
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4679
Practice Address - Country:US
Practice Address - Phone:951-693-4433
Practice Address - Fax:877-258-1326
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8963207R00000X, 207RC0000X
TX40364207RC0000X
CAC55461207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX162877802Medicaid
TX8DL072OtherBCBS
TXP01197255OtherRAILROAD MEDICARE
TX162877801Medicaid
TX162877802Medicaid
TX162877801Medicaid