Provider Demographics
NPI:1033274766
Name:ROSENBERG, BONNIE L (MD)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:L
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 BURGESS DR STE B
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MENLO PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94025-3476
Mailing Address - Country:US
Mailing Address - Phone:650-325-5055
Mailing Address - Fax:650-325-1295
Practice Address - Street 1:401 BURGESS DR STE B
Practice Address - Street 2:SUITE 201
Practice Address - City:MENLO PARK
Practice Address - State:CA
Practice Address - Zip Code:94025-3476
Practice Address - Country:US
Practice Address - Phone:650-325-5055
Practice Address - Fax:650-325-1295
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-22
Last Update Date:2015-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA061162174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG82149Medicare UPIN