Healthcare Provider Details

I. General information

NPI: 1477666733
Provider Name (Legal Business Name): IDALIA VANESSA ROSADO-TORRES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 05/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3802 POPLAR HILL RD STE C
CHESAPEAKE VA
23321-5531
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-673-8383
  • Fax: 757-483-9350
Mailing address:
  • Phone: 757-686-3508
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101256229
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: