Provider Demographics
NPI:1740560044
Name:ROSE, OLGA D (MD)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:D
Last Name:ROSE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:DOLGONOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3880 MURPHY CANYON RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4411
Mailing Address - Country:US
Mailing Address - Phone:858-636-4300
Mailing Address - Fax:858-636-4319
Practice Address - Street 1:7910 FROST STREET
Practice Address - Street 2:SUITE 350
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-2776
Practice Address - Country:US
Practice Address - Phone:858-496-4800
Practice Address - Fax:858-496-4850
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA143536208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics