# MARIANO L. ROSALES JR., M.D. S.C.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1386832228
- **Authorized official:** DR. MARIANO L ROSALES JR M.D. (PRESIDENT)
- **Authorized official phone:** (920) 324-3559

## Contact information

- **Practice address:** 600 FERN ST, WAUPUN, WI 53963-1018
- **Practice address phone:** (920) 324-3559
- **Practice address fax:** (920) 324-0258
- **Mailing address:** 600 FERN ST, WAUPUN, WI 53963-1018
- **Mailing address phone:** (920) 324-3559
- **Mailing address fax:** (920) 324-0258

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261Q00000X | Clinic/Center | 2190120 | WI | — |
| 261Q00000X | Clinic/Center | 2190620 | WI | Yes |

## Other

- **Enumeration date:** 10/04/2007
- **Last updated:** 10/04/2007