Provider Demographics
NPI:1457334781
Name:ROSES, JOAQUIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JOAQUIN
Middle Name:
Last Name:ROSES
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 1:601 E ARRELLAGA ST
Mailing Address - Street 2:STE 103
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93103-2274
Mailing Address - Country:US
Mailing Address - Phone:805-962-7685
Mailing Address - Fax:805-962-6152
Practice Address - Street 1:601 E ARRELLAGA ST
Practice Address - Street 2:STE 103
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93103-2274
Practice Address - Country:US
Practice Address - Phone:805-962-7685
Practice Address - Fax:805-962-6152
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA32983174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA84413Medicare UPIN
CAA32983Medicare ID - Type UnspecifiedPROVIDER NUMBER