Provider Demographics
NPI:1780656728
Name:ROSEN, ADAM S (DO)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:S
Last Name:ROSEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:FILE# 54433
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-0001
Mailing Address - Country:US
Mailing Address - Phone:858-784-5906
Mailing Address - Fax:858-784-5933
Practice Address - Street 1:10666 N TORREY PINES RD
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1027
Practice Address - Country:US
Practice Address - Phone:858-554-8178
Practice Address - Fax:858-784-5933
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20A9197207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX91970Medicaid
CAI31996Medicare UPIN
CAW20A9197AMedicare ID - Type UnspecifiedGROUP# W7168