Provider Demographics
NPI:1912210899
Name:D'SOUZA, RAKESH ROSHAN (MD)
Entity Type:Individual
Prefix:DR
First Name:RAKESH
Middle Name:ROSHAN
Last Name:D'SOUZA
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 1:603 S J ST STE 102
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4100
Mailing Address - Country:US
Mailing Address - Phone:253-396-4868
Mailing Address - Fax:253-396-4870
Practice Address - Street 1:603 S J ST STE 102
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4100
Practice Address - Country:US
Practice Address - Phone:253-396-4868
Practice Address - Fax:253-396-4870
Is Sole Proprietor?:No
Enumeration Date:2010-07-20
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD457491208000000X, 2080P0202X
WAMD607391642080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2079479Medicaid