Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 175F00000X | Naturopath | 705 | OR |
NPI | 1104114172 |
---|---|
Provider Name | Dr. Carlos A Rosas |
First Address | Portland, OR 97212-2923 |
Second Address | Portland, OR 97212-2923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |