Provider Demographics
NPI:1619997806
Name:ROSEN, SONJA LOUISA (MD)
Entity Type:Individual
Prefix:
First Name:SONJA
Middle Name:LOUISA
Last Name:ROSEN
Suffix:
Gender:F
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:PO BOX 54679
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90054-0679
Mailing Address - Country:US
Mailing Address - Phone:310-385-3511
Mailing Address - Fax:310-385-3229
Practice Address - Street 1:250 N ROBERTSON BLVD
Practice Address - Street 2:606
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1788
Practice Address - Country:US
Practice Address - Phone:310-385-3511
Practice Address - Fax:310-385-3229
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA82821207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A828210Medicaid
CAWA82821BMedicare PIN
CAI41694Medicare UPIN
CAWA82821AMedicare PIN