Healthcare Provider Details

I. General information

NPI: 1043342256
Provider Name (Legal Business Name): RONALD J ROSANDICH, M.D. P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8010 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7840
US

IV. Provider business mailing address

8010 MOUNTAIN RD NE
ALBUQUERQUE NM
87110-7840
US

V. Phone/Fax

Practice location:
  • Phone: 505-268-2481
  • Fax:
Mailing address:
  • Phone: 505-268-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number70-192
License Number StateNM

VIII. Authorized Official

Name: DR. RONALD JOHN ROSANDICH
Title or Position: PRESIDENT
Credential: MD
Phone: 505-268-2481