Provider Demographics
NPI:1316272107
Name:ROGES, OCTAVIANO A (MD)
Entity type:Individual
Prefix:DR
First Name:OCTAVIANO
Middle Name:A
Last Name:ROGES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 66596
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98166-0596
Mailing Address - Country:US
Mailing Address - Phone:714-353-3250
Mailing Address - Fax:714-533-3713
Practice Address - Street 1:1211 W LA PALMA AVE
Practice Address - Street 2:#408
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801-2815
Practice Address - Country:US
Practice Address - Phone:714-353-3250
Practice Address - Fax:714-386-5350
Is Sole Proprietor?:No
Enumeration Date:2009-10-12
Last Update Date:2024-10-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA106623207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine