Provider Demographics
NPI:1437189230
Name:KRIENGPRARTHANA, ROSARIN (MD)
Entity Type:Individual
Prefix:
First Name:ROSARIN
Middle Name:
Last Name:KRIENGPRARTHANA
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 1:10 ORIOLE CT
Mailing Address - Street 2:
Mailing Address - City:AMERICAN CANYON
Mailing Address - State:CA
Mailing Address - Zip Code:94503-3079
Mailing Address - Country:US
Mailing Address - Phone:909-213-0600
Mailing Address - Fax:
Practice Address - Street 1:10 ORIOLE CT
Practice Address - Street 2:
Practice Address - City:AMERICAN CANYON
Practice Address - State:CA
Practice Address - Zip Code:94503-3079
Practice Address - Country:US
Practice Address - Phone:909-213-0600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70576207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A705760Medicaid
H31533Medicare UPIN
00A705760Medicare ID - Type Unspecified