Provider Demographics
NPI:1801838610
Name:ROSETE, ROLLIE DUYAO (MD)
Entity Type:Individual
Prefix:
First Name:ROLLIE
Middle Name:DUYAO
Last Name:ROSETE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:4600 S TRACY BLVD
Mailing Address - Street 2:#107
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95377
Mailing Address - Country:US
Mailing Address - Phone:209-836-4920
Mailing Address - Fax:209-836-4935
Practice Address - Street 1:4600 S TRACY BLVD
Practice Address - Street 2:#107
Practice Address - City:TRACY
Practice Address - State:CA
Practice Address - Zip Code:95377
Practice Address - Country:US
Practice Address - Phone:209-836-4920
Practice Address - Fax:209-836-4935
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2018-06-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA53682207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G46409Medicare UPIN