1881973725 NPI number — JUAN ROSAS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881973725 NPI number — JUAN ROSAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSAS
Provider First Name:
JUAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROSAS
Provider Other First Name:
JOHN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1881973725
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1413 K ST NW FL 4
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20005-4577
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
681-443-5138
Provider Business Mailing Address Fax Number:
681-443-5138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1629 K ST NW STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20006-1631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-430-6249
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: EA890001 . This is a "BCBS PARTICIPATING PROVIDER NUMBER:" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".




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