Provider Demographics
NPI:1528090701
Name:RANGEL, ROSA LINDA (MD)
Entity type:Individual
Prefix:
First Name:ROSA
Middle Name:LINDA
Last Name:RANGEL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COUPEVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98239-3413
Mailing Address - Country:US
Mailing Address - Phone:360-678-5151
Mailing Address - Fax:
Practice Address - Street 1:101 N MAIN ST
Practice Address - Street 2:
Practice Address - City:COUPEVILLE
Practice Address - State:WA
Practice Address - Zip Code:98239-3413
Practice Address - Country:US
Practice Address - Phone:360-678-5151
Practice Address - Fax:360-678-7676
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC43297174400000X
WAMD60475665207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No174400000XOther Service ProvidersSpecialist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2039208Medicaid
CAGR0042050Medicaid
CAGR0042050Medicaid