Provider Demographics
NPI:1821073198
Name:FARRALES, ROEL DIZON (MD)
Entity Type:Individual
Prefix:DR
First Name:ROEL
Middle Name:DIZON
Last Name:FARRALES
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:PO BOX 410597
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94141-0597
Mailing Address - Country:US
Mailing Address - Phone:917-660-7790
Mailing Address - Fax:
Practice Address - Street 1:900 HYDE ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-4806
Practice Address - Country:US
Practice Address - Phone:415-441-6924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-09
Last Update Date:2008-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY232556207P00000X
CAA96148207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02647285Medicaid
NY1409Q1Medicare ID - Type Unspecified
NY02647285Medicaid