Healthcare Provider Details

I. General information

NPI: 1013769405
Provider Name (Legal Business Name): ODETTE MARIA ROSALES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2024
Last Update Date: 05/20/2026
Certification Date: 05/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 FRANCIS ST
BOSTON MA
02115-6105
US

IV. Provider business mailing address

45 FRANCIS ST
BOSTON MA
02115-6105
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-5500
  • Fax:
Mailing address:
  • Phone: 617-732-5500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number3018696
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: