Provider Demographics
NPI:1255326138
Name:ORBEGOSO, ROXANA (MD)
Entity Type:Individual
Prefix:DR
First Name:ROXANA
Middle Name:
Last Name:ORBEGOSO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10869 N SCOTTSDALE RD # 103-253
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-5280
Mailing Address - Country:US
Mailing Address - Phone:480-991-4707
Mailing Address - Fax:480-991-4707
Practice Address - Street 1:10869 N SCOTTSDALE RD # 103-253
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85254-5280
Practice Address - Country:US
Practice Address - Phone:480-991-4707
Practice Address - Fax:480-991-4707
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-15
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ33372207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ928426-01Medicaid
AZ102992Medicare ID - Type Unspecified
AZ928426-01Medicaid