Provider Demographics
NPI:1265500896
Name:ISKANDER, ROSANNA WADIE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROSANNA
Middle Name:WADIE
Last Name:ISKANDER
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 1:1330 W COVINA BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3200
Mailing Address - Country:US
Mailing Address - Phone:909-592-3323
Mailing Address - Fax:877-992-6240
Practice Address - Street 1:1330 W COVINA BLVD STE 102
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-3200
Practice Address - Country:US
Practice Address - Phone:909-592-3323
Practice Address - Fax:877-992-6240
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2019-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40133207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A401331Medicaid
CA00A401330Medicaid
CA00A401330Medicaid
CA00A401331Medicaid