Healthcare Provider Details

I. General information

NPI: 1205332624
Provider Name (Legal Business Name): MICHAEL GIANCARLO ROSCO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: MIKE ROSCO MD

II. Dates (important events)

Enumeration Date: 04/04/2018
Last Update Date: 04/17/2026
Certification Date: 04/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 N PALM CANYON DR STE 202
PALM SPRINGS CA
92262-4434
US

IV. Provider business mailing address

1401 N PALM CANYON DR STE 202
PALM SPRINGS CA
92262-4434
US

V. Phone/Fax

Practice location:
  • Phone: 424-239-9164
  • Fax: 760-827-3601
Mailing address:
  • Phone: 760-424-8952
  • Fax: 760-827-3601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA165095
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: