Healthcare Provider Details

I. General information

NPI: 1497053524
Provider Name (Legal Business Name): ANGELA A ROSALES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2011
Last Update Date: 03/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

163 GORE ST
CAMBRIDGE MA
02141-1119
US

IV. Provider business mailing address

163 GORE ST
CAMBRIDGE MA
02141-1119
US

V. Phone/Fax

Practice location:
  • Phone: 617-665-3000
  • Fax:
Mailing address:
  • Phone: 617-665-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number196536
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: