Basic Information
| Provider Information | |||||||||
| NPI: | 1265415830 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAGGE | ||||||||
| FirstName: | ROSALIE | ||||||||
| MiddleName: | JANE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | PAISLEY | ||||||||
| OtherFirstName: | ROSALIE | ||||||||
| OtherMiddleName: | JANE | ||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4860 Y ST | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167032273 | ||||||||
| FaxNumber: | 9167032274 | ||||||||
| Practice Location | |||||||||
| Address1: | 4860 Y ST | ||||||||
| Address2: | SUITE 3100 | ||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958172307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167032273 | ||||||||
| FaxNumber: | 9167032274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/28/2005 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
| AuthorizedOfficialFirstName: | |||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | |||||||||
| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | X | ||||||||
| IsOrganizationSubpart: | |||||||||
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| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207U00000X | G86720 | CA | X | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207U00000X | 98-00887 | NC | X | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207U00000X | L3672 | TX | X | Allopathic & Osteopathic Physicians | Nuclear Medicine | 207U00000X | MED101722 | MO | X | Allopathic & Osteopathic Physicians | Nuclear Medicine | 2085R0202X | G86720 | CA | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | 98-00887 | NC | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | L3672 | TX | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0202X | MED101722 | MO | X | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 00G867200 | 05 | CA | MEDICAID |