Provider Demographics
NPI:1770655821
Name:ROSARIO, MARSHAL D (MD)
Entity Type:Individual
Prefix:
First Name:MARSHAL
Middle Name:D
Last Name:ROSARIO
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 1:951 BERRY AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94024-5532
Mailing Address - Country:US
Mailing Address - Phone:650-793-5574
Mailing Address - Fax:650-938-3111
Practice Address - Street 1:951 BERRY AVE
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94024-5532
Practice Address - Country:US
Practice Address - Phone:408-828-7334
Practice Address - Fax:650-938-3111
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2019-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG037569207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47140Medicare UPIN
CA00G375690Medicare ID - Type Unspecified