Provider Demographics
NPI:1073292157
Name:ROSEN INTERNAL MEDICINE A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:ROSEN INTERNAL MEDICINE A PROFESSIONAL CORP
Other - Org Name:ROSEN PERSONALIZED MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-378-2007
Mailing Address - Street 1:400 TAYLOR BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-2160
Mailing Address - Country:US
Mailing Address - Phone:925-378-2007
Mailing Address - Fax:925-363-0077
Practice Address - Street 1:400 TAYLOR BLVD STE 304
Practice Address - Street 2:
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-2160
Practice Address - Country:US
Practice Address - Phone:925-363-0069
Practice Address - Fax:925-363-0077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-14
Last Update Date:2024-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty