Provider Demographics
NPI:1447242300
Name:ROJAS, OSCAR I (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:I
Last Name:ROJAS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 W TARGET RANGE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NOGALES
Mailing Address - State:AZ
Mailing Address - Zip Code:85621-2466
Mailing Address - Country:US
Mailing Address - Phone:520-287-4656
Mailing Address - Fax:520-287-2444
Practice Address - Street 1:1209 W TARGET RANGE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:NOGALES
Practice Address - State:AZ
Practice Address - Zip Code:85621-2466
Practice Address - Country:US
Practice Address - Phone:520-287-4656
Practice Address - Fax:520-287-2444
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2013-06-26
Deactivation Date:2006-03-23
Deactivation Code:
Reactivation Date:2006-03-29
Provider Licenses
StateLicense IDTaxonomies
AZ186412080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ287004001Medicaid