Provider Demographics
NPI:1376613158
Name:AGSALDA-ROSENBUSH, VANESSA MAE (MD)
Entity Type:Individual
Prefix:DR
First Name:VANESSA
Middle Name:MAE
Last Name:AGSALDA-ROSENBUSH
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 1:66-125 KAMEHAMEHA HWY
Mailing Address - Street 2:
Mailing Address - City:HALEIWA
Mailing Address - State:HI
Mailing Address - Zip Code:96712-1420
Mailing Address - Country:US
Mailing Address - Phone:808-637-5087
Mailing Address - Fax:
Practice Address - Street 1:66-125 KAMEHAMEHA HWY
Practice Address - Street 2:
Practice Address - City:HALEIWA
Practice Address - State:HI
Practice Address - Zip Code:96712-1420
Practice Address - Country:US
Practice Address - Phone:808-637-5087
Practice Address - Fax:808-637-4765
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI11384207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HI501983Medicaid
HI54026Medicare ID - Type Unspecified
HI501983Medicaid