MEDICARE: ROSA BORDERS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	MD00029107	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356394019
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSA BORDERS MD

Provider Business Mailing Address
First Line	:	320 W 10TH AVE
Second Line	:	SUITE 106
City	:	KENNEWICK
State	:	WA
Zip	:	99336-6302
Country	:	US
Telephone Number	:	509-586-5897
Fax Number	:	509-586-5897

Provider Business Practice Location Address
First Line	:	521 N YOUNG ST
Second Line	:	KGH MEDICAL MALL
City	:	KENNEWICK
State	:	WA
Zip	:	99336-7806
Country	:	US
Telephone Number	:	509-585-5222
Fax Number	:	509-585-5271

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/17/2006
Last Update Date	:	07/08/2007

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Directions to “ ROSA BORDERS MD” Practice Location

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