Provider Demographics
NPI:1053584540
Name:ROSARIO, CRAIG CHARLES (IDC)
Entity type:Individual
Prefix:MR
First Name:CRAIG
Middle Name:CHARLES
Last Name:ROSARIO
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:531 DAKOTA WAY
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-5671
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:MCAS BMC MIRAMAR
Practice Address - Street 2:BLDG 2496, BAUER RD.
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92145
Practice Address - Country:US
Practice Address - Phone:858-577-4656
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2008-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman