Provider Demographics
NPI:1770017634
Name:ROSE MEDICAL SYSTEMS, INC.
Entity Type:Organization
Organization Name:ROSE MEDICAL SYSTEMS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:760-889-4000
Mailing Address - Street 1:2410 SACADA CIR
Mailing Address - Street 2:SUITE B
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8051
Mailing Address - Country:US
Mailing Address - Phone:760-889-4000
Mailing Address - Fax:
Practice Address - Street 1:2410 SACADA CIR
Practice Address - Street 2:SUITE B
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8051
Practice Address - Country:US
Practice Address - Phone:760-889-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA10054450OtherFDA REGISTRATION NUMBER