Provider Demographics
NPI:1265553457
Name:JADIA, ROSEMARY RUPALI (DPM)
Entity type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:RUPALI
Last Name:JADIA
Suffix:
Gender:F
Credentials:DPM
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 77790
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92877-0126
Mailing Address - Country:US
Mailing Address - Phone:951-278-5590
Mailing Address - Fax:951-272-9924
Practice Address - Street 1:18332 BIRCH ST
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-6604
Practice Address - Country:US
Practice Address - Phone:951-278-5590
Practice Address - Fax:951-272-9924
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4593213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV07563Medicare UPIN
CAE4593Medicare ID - Type Unspecified