Provider Demographics
NPI:1497868376
Name:ROSAASEN, AMANDA R (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:R
Last Name:ROSAASEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:187 E WILBUR RD # 100
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5572
Mailing Address - Country:US
Mailing Address - Phone:805-492-1015
Mailing Address - Fax:805-492-2035
Practice Address - Street 1:187 E WILBUR RD # 100
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5572
Practice Address - Country:US
Practice Address - Phone:805-492-1015
Practice Address - Fax:805-492-2035
Is Sole Proprietor?:No
Enumeration Date:2006-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85780207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR8655221OtherDEA
CAI47295Medicare UPIN