Provider Demographics
NPI:1235316175
Name:ROSENBERG, BERNADETTE R (DO)
Entity Type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:R
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3108 N 17TH AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-5802
Mailing Address - Country:US
Mailing Address - Phone:480-694-9021
Mailing Address - Fax:
Practice Address - Street 1:815 E UNIVERSITY DR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-8032
Practice Address - Country:US
Practice Address - Phone:480-507-2199
Practice Address - Fax:480-649-3416
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMA-2168-18208000000X
AZ4749208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics