Provider Demographics
NPI:1033211008
Name:ROSOVE, SHERMAN P (MD)
Entity Type:Individual
Prefix:
First Name:SHERMAN
Middle Name:P
Last Name:ROSOVE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25050 AVENUE KEARNY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1255
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:1663 BEVERLY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5747
Practice Address - Country:US
Practice Address - Phone:213-250-0235
Practice Address - Fax:213-250-0439
Is Sole Proprietor?:No
Enumeration Date:2006-09-01
Last Update Date:2014-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAC25993207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC25993OtherCA STATE MED LICENSE
CAC25993OtherCA STATE MED LICENSE
CA110095099OtherRAILROAD MEDICARE ID
CA110095099OtherRAILROAD MEDICARE ID
CA00C259930Medicaid
CAHC25993Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID