Healthcare Provider Details

I. General information

NPI: 1285196873
Provider Name (Legal Business Name): ROSA VIRGINIA WHITE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ROSA VIRGINIA GUEDEZ BAUTE M.D.

II. Dates (important events)

Enumeration Date: 04/02/2019
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3435 W BROADWAY AVE STE 1135
ROBBINSDALE MN
55422-2974
US

IV. Provider business mailing address

3435 W BROADWAY AVE STE 1135
ROBBINSDALE MN
55422-2974
US

V. Phone/Fax

Practice location:
  • Phone: 763-581-2800
  • Fax:
Mailing address:
  • Phone: 763-581-2800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number80098
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: