Healthcare Provider Details

I. General information

NPI: 1982627998
Provider Name (Legal Business Name): JOAQUIN PATRICIO ROSALES JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 CONTEMPO AVE
WEST MONROE LA
71291-5312
US

IV. Provider business mailing address

104 CONTEMPO AVE
WEST MONROE LA
71291-5312
US

V. Phone/Fax

Practice location:
  • Phone: 318-807-1360
  • Fax: 318-807-1364
Mailing address:
  • Phone: 318-807-1360
  • Fax: 318-807-1364

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number017751
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License NumberMD017751
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: