Healthcare Provider Details

I. General information

NPI: 1528591625
Provider Name (Legal Business Name): LEONEL OLIVEROS-ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2017
Last Update Date: 07/30/2026
Certification Date: 07/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1344 WINTERGREEN LN NE
BAINBRIDGE ISLAND WA
98110-5118
US

IV. Provider business mailing address

PO BOX 741515
LOS ANGELES CA
90074-1515
US

V. Phone/Fax

Practice location:
  • Phone: 206-842-5632
  • Fax: 206-842-5992
Mailing address:
  • Phone: 206-842-5632
  • Fax: 206-842-5992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61037696
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: