Provider Demographics
NPI:1982627998
Name:ROSALES, JOAQUIN PATRICIO JR (MD)
Entity Type:Individual
Prefix:
First Name:JOAQUIN
Middle Name:PATRICIO
Last Name:ROSALES
Suffix:JR
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 1:104 CONTEMPO AVE
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-5312
Mailing Address - Country:US
Mailing Address - Phone:318-807-1360
Mailing Address - Fax:318-807-1364
Practice Address - Street 1:104 CONTEMPO AVE
Practice Address - Street 2:
Practice Address - City:WEST MONROE
Practice Address - State:LA
Practice Address - Zip Code:71291
Practice Address - Country:US
Practice Address - Phone:318-807-1360
Practice Address - Fax:318-807-1364
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD0177512080P0203X
LA017751208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080P0203XAllopathic & Osteopathic PhysiciansPediatricsPediatric Critical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1348597Medicaid
LA1348597Medicaid