Healthcare Provider Details

I. General information

NPI: 1366019531
Provider Name (Legal Business Name): JASON ROOS DO A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/07/2021
Last Update Date: 01/03/2026
Certification Date: 01/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 W WALNUT AVE STE A
VISALIA CA
93277-6233
US

IV. Provider business mailing address

1700 W WALNUT AVE STE A
VISALIA CA
93277-6233
US

V. Phone/Fax

Practice location:
  • Phone: 559-409-4720
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YX0905X
TaxonomyOtolaryngology/Facial Plastic Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: JASON ROOS
Title or Position: OWNER
Credential: DO
Phone: 509-720-6659