Provider Demographics
NPI:1457533440
Name:ROSAS CARRILLO, RAMIRO (DDS)
Entity Type:Individual
Prefix:
First Name:RAMIRO
Middle Name:
Last Name:ROSAS CARRILLO
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-2706
Mailing Address - Country:US
Mailing Address - Phone:619-422-8891
Mailing Address - Fax:619-422-4356
Practice Address - Street 1:1101 BROADWAY
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-2706
Practice Address - Country:US
Practice Address - Phone:619-422-8891
Practice Address - Fax:619-422-4356
Is Sole Proprietor?:No
Enumeration Date:2007-11-30
Last Update Date:2007-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA566361223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice