Provider Demographics
NPI:1558389304
Name:ROSEBROCK, KLAUS PETER (MD)
Entity Type:Individual
Prefix:
First Name:KLAUS
Middle Name:PETER
Last Name:ROSEBROCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR
Mailing Address - Street 2:#100
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0315
Mailing Address - Country:US
Mailing Address - Phone:949-552-4584
Mailing Address - Fax:949-551-5612
Practice Address - Street 1:14150 CULVER DR
Practice Address - Street 2:#100
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0315
Practice Address - Country:US
Practice Address - Phone:949-552-4584
Practice Address - Fax:949-551-5612
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2012-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA45482207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A454821Medicaid
CA00A454821Medicaid