Provider Demographics
NPI:1861916116
Name:ROSAS, JOSEPH
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:
Last Name:ROSAS
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 1:1164 ROSLYN ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-3163
Mailing Address - Country:US
Mailing Address - Phone:850-607-4098
Mailing Address - Fax:
Practice Address - Street 1:PLACE BRIDGE ACADEMY
Practice Address - Street 2:7125 CHERRY CREEK N
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80224
Practice Address - Country:US
Practice Address - Phone:720-424-0528
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-07-28
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0005087363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant