Healthcare Provider Details

I. General information

NPI: 1740331628
Provider Name (Legal Business Name): YITZHAK JOEL ROSEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JOEL ROSEN MD

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 05/13/2025
Certification Date: 05/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1640 CALLE MEDICO STE E
SANTA FE NM
87505-4829
US

IV. Provider business mailing address

1640 CALLE MEDICO STE E
SANTA FE NM
87505-4829
US

V. Phone/Fax

Practice location:
  • Phone: 505-386-1383
  • Fax: 505-393-3883
Mailing address:
  • Phone: 505-386-1380
  • Fax: 505-393-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD2003-0626
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: