Provider Demographics
NPI:1366497505
Name:ROSARIO, BRUNILDA A (DO)
Entity Type:Individual
Prefix:
First Name:BRUNILDA
Middle Name:A
Last Name:ROSARIO
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:11435 W BUCKEYE RD
Mailing Address - Street 2:STE 104-450
Mailing Address - City:AVONDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85323-6812
Mailing Address - Country:US
Mailing Address - Phone:623-536-2413
Mailing Address - Fax:623-536-2909
Practice Address - Street 1:700 N ESTRELLA PKWY
Practice Address - Street 2:STE 125
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-9271
Practice Address - Country:US
Practice Address - Phone:623-536-2413
Practice Address - Fax:623-536-2909
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-24
Last Update Date:2017-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ4107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ890378Medicaid
AZZ146561Medicare PIN
AZI16304Medicare UPIN