Provider Demographics
NPI:1619043445
Name:ROSALES, STEVEN JOSEPH (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:JOSEPH
Last Name:ROSALES
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EL SEGUNDO
Mailing Address - State:CA
Mailing Address - Zip Code:90245-3006
Mailing Address - Country:US
Mailing Address - Phone:310-615-9941
Mailing Address - Fax:310-615-9941
Practice Address - Street 1:533 MAIN ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-3006
Practice Address - Country:US
Practice Address - Phone:310-615-9941
Practice Address - Fax:310-615-9941
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10831T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0108310Medicaid
CASD0108310Medicaid
CAOP10831AMedicare ID - Type Unspecified