Provider Demographics
NPI:1497881486
Name:ROSEN, REBECCA LAURA (MD)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LAURA
Last Name:ROSEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:9333 GENES SUITE 200
Mailing Address - Street 2:UCSD FAMILY AND SPORTS MEDICINE AT LA JOLLA
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121
Mailing Address - Country:US
Mailing Address - Phone:858-657-8600
Mailing Address - Fax:858-657-8625
Practice Address - Street 1:9333 GENESEE AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-2111
Practice Address - Country:US
Practice Address - Phone:858-657-8600
Practice Address - Fax:858-657-8625
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA67987207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA94-6000524OtherCOUNTY OF MONTEREY EIN
CAH34388Medicare UPIN
CAZZZ02040ZMedicare ID - Type UnspecifiedCOUNTY OF MONTEREY GROUP