Provider Demographics
NPI:1881618171
Name:ROSALES, NOEL (MD)
Entity type:Individual
Prefix:DR
First Name:NOEL
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 POST ST
Mailing Address - Street 2:SUITE 320
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115-3465
Mailing Address - Country:US
Mailing Address - Phone:415-885-7478
Mailing Address - Fax:415-885-3790
Practice Address - Street 1:2330 POST ST
Practice Address - Street 2:SUITE 320
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115-3465
Practice Address - Country:US
Practice Address - Phone:415-885-7478
Practice Address - Fax:415-885-3790
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2016-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD417311208000000X
CAG78012208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001881080Medicaid
PA055824Medicare ID - Type Unspecified
PA001881080Medicaid