Provider Demographics
NPI:1346488905
Name:ROSALES, VICTOR G (DO)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:G
Last Name:ROSALES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6101 BLUE LAGOON DR STE 400
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2051
Mailing Address - Country:US
Mailing Address - Phone:305-500-2027
Mailing Address - Fax:305-500-2155
Practice Address - Street 1:4455 THOUSAND OAKS DR
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78233-6801
Practice Address - Country:US
Practice Address - Phone:726-268-7360
Practice Address - Fax:877-370-4369
Is Sole Proprietor?:No
Enumeration Date:2009-02-04
Last Update Date:2023-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM8962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXM8962OtherLICENSE
TX205530303Medicaid
TX269448ZLM2Medicare PIN