Provider Demographics
NPI:1386961563
Name:HUMBERTO ROSADO MEDICAL, PLLC
Entity type:Organization
Organization Name:HUMBERTO ROSADO MEDICAL, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUMBERTO
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSADO
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:928-247-9162
Mailing Address - Street 1:1763 W. 24TH ST.
Mailing Address - Street 2:SUITE 102
Mailing Address - City:YUMA
Mailing Address - State:AZ
Mailing Address - Zip Code:85364-6219
Mailing Address - Country:US
Mailing Address - Phone:928-247-9162
Mailing Address - Fax:928-247-9164
Practice Address - Street 1:1763 W. 24TH ST.
Practice Address - Street 2:SUITE 102
Practice Address - City:YUMA
Practice Address - State:AZ
Practice Address - Zip Code:85364-6219
Practice Address - Country:US
Practice Address - Phone:928-247-9162
Practice Address - Fax:928-247-9164
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ19978207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty