Provider Demographics
NPI:1811621543
Name:ROSALES MADRID, LILIAN MARISOL
Entity Type:Individual
Prefix:
First Name:LILIAN
Middle Name:MARISOL
Last Name:ROSALES MADRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIAN
Other - Middle Name:MARISOL
Other - Last Name:ROSALES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 WESLEY DREW LN NW
Mailing Address - Street 2:
Mailing Address - City:CARTERSVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30121-4636
Mailing Address - Country:US
Mailing Address - Phone:706-266-1014
Mailing Address - Fax:
Practice Address - Street 1:2141 KINGSTON CT SE STE 103
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30067-8928
Practice Address - Country:US
Practice Address - Phone:770-644-0555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-07-09
Last Update Date:2022-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN