Provider Demographics
NPI:1841203882
Name:ROSARIO, MANUEL GALICIA (DO)
Entity Type:Individual
Prefix:DR
First Name:MANUEL
Middle Name:GALICIA
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 27298
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-7289
Mailing Address - Country:US
Mailing Address - Phone:714-495-4050
Mailing Address - Fax:714-497-1485
Practice Address - Street 1:1950 EAST 17TH STREET
Practice Address - Street 2:SUITE #200
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-6852
Practice Address - Country:US
Practice Address - Phone:714-495-4050
Practice Address - Fax:714-495-4050
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-088555208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW20A9156AMedicare PIN
CAA38404Medicare UPIN
CAW5010Medicare PIN