| Wandisan And Rosete Medical Group Professional Corporation | |
|
4600 S Tracy Blvd #107 Tracy CA 95377 | |
| (209) 836-4920 | |
| (209) 836-4935 |
| Full Name | Wandisan And Rosete Medical Group Professional Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 4600 S Tracy Blvd #107, Tracy, California |
| Authorized Official Name and Position | Florence Wandisan Rosete (CFO) |
| Authorized Official Contact | 2098364920 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Wandisan And Rosete Medical Group Professional Corporation 4600 S Tracy Blvd #107 Tracy CA 95377 Ph: (209) 836-4920 | Wandisan And Rosete Medical Group Professional Corporation 4600 S Tracy Blvd #107 Tracy CA 95377 Ph: (209) 836-4920 |
| NPI Number | 1316058795 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 07/10/2018 |
| Medicare PECOS PAC ID | 5193612133 |
|---|---|
| Medicare Enrollment ID | O20040303000608 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1316058795 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A72169 (California) | Primary |
| Provider Name | Rollie D Rosete |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1801838610 PECOS PAC ID: 9234026279 Enrollment ID: I20040305000848 |
| Provider Name | Florence L Wandisan-rosete |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1457396897 PECOS PAC ID: 1951298991 Enrollment ID: I20040305000893 |
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