Healthcare Provider Details

I. General information

NPI: 1831776137
Provider Name (Legal Business Name): RENAN AVILIO FERRUFINO ROSALES MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 01/29/2025
Certification Date: 01/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 WASHINGTON ST ZISKIND BUILDING, 6TH FLOOR
BOSTON MA
02111-1552
US

IV. Provider business mailing address

800 WASHINGTON ST ZISKIND BUILDING, 6TH FLOOR
BOSTON MA
02111
US

V. Phone/Fax

Practice location:
  • Phone: 617-636-6044
  • Fax:
Mailing address:
  • Phone: 617-636-6044
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number1021183
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: