Provider Demographics
NPI:1497788772
Name:ROZENDAL, FREDERICK GENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:GENE
Last Name:ROZENDAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 BOLLING CIR
Mailing Address - Street 2:
Mailing Address - City:NOVATO
Mailing Address - State:CA
Mailing Address - Zip Code:94949-4548
Mailing Address - Country:US
Mailing Address - Phone:415-272-4424
Mailing Address - Fax:415-506-4018
Practice Address - Street 1:946 IRVING ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94122-2207
Practice Address - Country:US
Practice Address - Phone:415-272-4424
Practice Address - Fax:415-506-4018
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-09
Last Update Date:2017-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10271103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PL102711Medicare ID - Type UnspecifiedPSYCHOLOGIST
CAR23585Medicare UPIN
CA0PL102710Medicare ID - Type UnspecifiedPSYCHOLOGIST