NPIMap

Organization Active NPI

Mariano L. Rosales Jr., M.D. S.C.

  • Clinic/Center
  • Waupun, WI
National Provider Identifier
1386832228
Registry record updated Oct 4, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
License
2190620 Issued in WI
Legal business name
MARIANO L. ROSALES JR., M.D. S.C.
Practice address
600 Fern St
Waupun, WI 53963-1018
Phone
(920) 324-3559
Fax
(920) 324-0258
NPI assigned
Oct 4, 2007
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 4, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mariano L Rosales Jr, M.D.
Title
President
Phone
(920) 324-3559

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X 2190120 WI
Clinic/Center 261Q00000X 2190620 WI Primary

Addresses

Primary practice location

600 Fern St
Waupun, WI 53963-1018

Mailing address

600 Fern St
Waupun, WI 53963-1018
Phone (920) 324-3559

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1191456000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1191456000000",
    "number": "1386832228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 FERN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631018",
            "telephone_number": "920-324-3559",
            "fax_number": "920-324-0258"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 FERN ST",
            "city": "WAUPUN",
            "state": "WI",
            "postal_code": "539631018",
            "telephone_number": "920-324-3559",
            "fax_number": "920-324-0258"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARIANO L. ROSALES JR., M.D. S.C.",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-04",
        "last_updated": "2007-10-04",
        "status": "A",
        "authorized_official_last_name": "ROSALES JR",
        "authorized_official_first_name": "MARIANO",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "920-324-3559",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "2190120",
            "primary": false
        },
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "WI",
            "license": "2190620",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Waupun, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 4, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.