Provider Demographics
NPI:1871731331
Name:ROSSI, NELLO ALFRED (MD)
Entity type:Individual
Prefix:
First Name:NELLO
Middle Name:ALFRED
Last Name:ROSSI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E MONTEREY WAY
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85012-2619
Mailing Address - Country:US
Mailing Address - Phone:602-296-4477
Mailing Address - Fax:602-296-4044
Practice Address - Street 1:201 E MONTEREY WAY
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85012-2619
Practice Address - Country:US
Practice Address - Phone:602-296-4477
Practice Address - Fax:602-296-4044
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-21
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13486207R00000X
CAG54803207R00000X
IL036.129425207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
N/AOtherN/A