Provider Demographics
NPI:1639497639
Name:HAROLD N. ROSENGREN, M.D., A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:HAROLD N. ROSENGREN, M.D., A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:N
Authorized Official - Last Name:ROSENGREN
Authorized Official - Suffix:JR
Authorized Official - Credentials:DM
Authorized Official - Phone:805-983-0880
Mailing Address - Street 1:1100 W GONZALES RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93036-3336
Mailing Address - Country:US
Mailing Address - Phone:805-983-0880
Mailing Address - Fax:805-983-0408
Practice Address - Street 1:1100 W GONZALES RD
Practice Address - Street 2:SUITE 102
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-3336
Practice Address - Country:US
Practice Address - Phone:805-983-0880
Practice Address - Fax:805-983-0408
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-14
Last Update Date:2010-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG15538207KA0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG15538Medicare PIN