Provider Demographics
NPI:1053327239
Name:ROSENBERG, RICHARD ARTHUR (DPM)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:ARTHUR
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3300 E SOUTH ST
Mailing Address - Street 2:SUITE #306
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90805-4549
Mailing Address - Country:US
Mailing Address - Phone:562-633-5881
Mailing Address - Fax:562-633-3646
Practice Address - Street 1:3300 E SOUTH ST
Practice Address - Street 2:SUITE #306
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90805-4549
Practice Address - Country:US
Practice Address - Phone:562-633-5881
Practice Address - Fax:562-633-3646
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2466213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5538030001Medicare NSC
E2466Medicare ID - Type Unspecified
T11343Medicare UPIN