Provider Demographics
NPI:1689742702
Name:GIDOWSKI, ROSA MARIA (MD)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:MARIA
Last Name:GIDOWSKI
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 1:368 W BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2212
Mailing Address - Country:US
Mailing Address - Phone:626-915-5161
Mailing Address - Fax:626-915-5162
Practice Address - Street 1:368 W BADILLO ST
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-2212
Practice Address - Country:US
Practice Address - Phone:626-915-5161
Practice Address - Fax:626-915-5162
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2013-01-03
Deactivation Date:2012-09-17
Deactivation Code:
Reactivation Date:2012-12-26
Provider Licenses
StateLicense IDTaxonomies
CAA53575208000000X, 208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
H11807Medicare UPIN