Provider Demographics
NPI:1811018021
Name:ROSEMARY R. JADIA, D.P.M.
Entity type:Organization
Organization Name:ROSEMARY R. JADIA, D.P.M.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JADIA
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:951-278-5590
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-03
Last Update Date:2012-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4593261QP1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP1100XAmbulatory Health Care FacilitiesClinic/CenterPodiatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4593Medicare ID - Type Unspecified
CAV07563Medicare UPIN