Provider Demographics
NPI:1952740862
Name:ROSALES BARRAGAN, DAPHNE MAGDALENA (MD)
Entity type:Individual
Prefix:
First Name:DAPHNE
Middle Name:MAGDALENA
Last Name:ROSALES BARRAGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5055 E BROADWAY BLVD STE A100
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3629
Mailing Address - Country:US
Mailing Address - Phone:520-547-0611
Mailing Address - Fax:520-547-0616
Practice Address - Street 1:7105 N LA CHOLLA BLVD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85741-3112
Practice Address - Country:US
Practice Address - Phone:520-547-0611
Practice Address - Fax:520-547-0616
Is Sole Proprietor?:No
Enumeration Date:2013-06-25
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZR74127207Q00000X
AZ51782207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine