Provider Demographics
NPI:1871170597
Name:ROSALES, JOSHUA ALEXANDRE
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:ALEXANDRE
Last Name:ROSALES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9084 GRAMERCY DR APT 146
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-2307
Mailing Address - Country:US
Mailing Address - Phone:818-326-6462
Mailing Address - Fax:
Practice Address - Street 1:604 N 16TH ST # 255A
Practice Address - Street 2:
Practice Address - City:MILWAUKEE
Practice Address - State:WI
Practice Address - Zip Code:53233-2117
Practice Address - Country:US
Practice Address - Phone:414-288-4470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-27
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WITBD2255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer