Provider Demographics
NPI:1477579142
Name:ENDOZO, ROSALIE M (P,A)
Entity Type:Individual
Prefix:MRS
First Name:ROSALIE
Middle Name:M
Last Name:ENDOZO
Suffix:
Gender:F
Credentials:P,A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9436 SLAUSON AVE
Mailing Address - Street 2:
Mailing Address - City:PICO RIVERA
Mailing Address - State:CA
Mailing Address - Zip Code:90660-4748
Mailing Address - Country:US
Mailing Address - Phone:562-949-6069
Mailing Address - Fax:562-949-0199
Practice Address - Street 1:9436 SLAUSON AVE
Practice Address - Street 2:
Practice Address - City:PICO RIVERA
Practice Address - State:CA
Practice Address - Zip Code:90660-4748
Practice Address - Country:US
Practice Address - Phone:562-949-6069
Practice Address - Fax:562-949-0199
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17672363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant