Provider Demographics
NPI:1275582892
Name:ROSALES, NELSON R (DO)
Entity Type:Individual
Prefix:DR
First Name:NELSON
Middle Name:R
Last Name:ROSALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:NELSON
Other - Middle Name:RAMON
Other - Last Name:ROSALES ABREGO
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:17095 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-6004
Mailing Address - Country:US
Mailing Address - Phone:760-241-6666
Mailing Address - Fax:760-241-7575
Practice Address - Street 1:12550 HESPERIA RD
Practice Address - Street 2:STE 100
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-0000
Practice Address - Country:US
Practice Address - Phone:760-241-6666
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8484207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR8561929OtherDEA