Provider Demographics
NPI:1760493712
Name:ROSIN, BENJAMIN LEE (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:LEE
Last Name:ROSIN
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 1:3330 LOMITA BLVD
Mailing Address - Street 2:ATTN CARDIOLOGY DEPT
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5002
Mailing Address - Country:US
Mailing Address - Phone:310-784-4800
Mailing Address - Fax:310-316-9188
Practice Address - Street 1:3330 LOMITA BLVD
Practice Address - Street 2:ATTN CARDILOGY DEPT
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-5002
Practice Address - Country:US
Practice Address - Phone:310-784-4800
Practice Address - Fax:310-316-9188
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-11
Last Update Date:2010-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG13906207RC0000X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G139060OtherBC AND BS
CA952815128OtherEIN
CAA39113Medicare UPIN
CAG13906Medicare ID - Type Unspecified