Provider Demographics
NPI:1083800957
Name:ROSENTHAL, STEVEN BRADLEY (MS, L AC)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:BRADLEY
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MS, L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4315 ATHENS ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92115-6104
Mailing Address - Country:US
Mailing Address - Phone:619-287-0554
Mailing Address - Fax:619-444-6174
Practice Address - Street 1:1530 JAMACHA RD
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92019-3700
Practice Address - Country:US
Practice Address - Phone:619-444-3477
Practice Address - Fax:619-444-6174
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-24
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
133N00000X
CA9008171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No133N00000XDietary & Nutritional Service ProvidersNutritionist