Healthcare Provider Details

I. General information

NPI: 1467444380
Provider Name (Legal Business Name): EUGENE H ROOS DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2005
Last Update Date: 05/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 MOUNT VERNON AVE
BAKERSFIELD CA
93306-4018
US

IV. Provider business mailing address

PO BOX 35000
BAKERSFIELD CA
93385-5000
US

V. Phone/Fax

Practice location:
  • Phone: 949-326-2334
  • Fax: 661-326-2982
Mailing address:
  • Phone: 661-326-2334
  • Fax: 661-326-2982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number20A6326
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2085N0700X
TaxonomyNeuroradiology Physician
License Number20A6326
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: