Provider Demographics
NPI:1881041978
Name:SALVATORE ROSANIO M D INC
Entity Type:Organization
Organization Name:SALVATORE ROSANIO M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SALVATORE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSANIO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:951-698-4433
Mailing Address - Street 1:PO BOX 899
Mailing Address - Street 2:
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629-0899
Mailing Address - Country:US
Mailing Address - Phone:409-256-6862
Mailing Address - Fax:949-545-7765
Practice Address - Street 1:27555 YNEZ RD STE 400
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4679
Practice Address - Country:US
Practice Address - Phone:951-693-4433
Practice Address - Fax:877-258-1326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-18
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC55461207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB238896OtherMEDICARE PTAN
CAPO1518446OtherRAILROAD MEDICARE PTAN