Provider Demographics
NPI:1255358974
Name:ROGALA, CAROL (DO)
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:
Last Name:ROGALA
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3877 N 7TH ST STE 400
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85014-5061
Mailing Address - Country:US
Mailing Address - Phone:602-258-6797
Mailing Address - Fax:602-248-8113
Practice Address - Street 1:1209 S 1ST AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85003-2692
Practice Address - Country:US
Practice Address - Phone:602-258-6797
Practice Address - Fax:602-248-8113
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8408207P00000X
AZ008125207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX84080Medicaid
CAAZ937XMedicare PIN
CAAZ937YMedicare PIN