Provider Demographics
NPI:1487482709
Name:ROSALES, ANDRES (DC)
Entity type:Individual
Prefix:
First Name:ANDRES
Middle Name:
Last Name:ROSALES
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9150 WILSHIRE BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3429
Mailing Address - Country:US
Mailing Address - Phone:310-738-3991
Mailing Address - Fax:
Practice Address - Street 1:9150 WILSHIRE BLVD STE 250
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3429
Practice Address - Country:US
Practice Address - Phone:310-738-3991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-26
Last Update Date:2024-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC37015111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor