Provider Demographics
NPI:1790765451
Name:SHORENSTEIN, ROSALIND G (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:G
Last Name:SHORENSTEIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:218 EL PINAR
Mailing Address - Street 2:
Mailing Address - City:LA SELVA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:95076-1515
Mailing Address - Country:US
Mailing Address - Phone:831-818-1206
Mailing Address - Fax:
Practice Address - Street 1:700 FREDERICK ST
Practice Address - Street 2:SUITE 103
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-2239
Practice Address - Country:US
Practice Address - Phone:831-458-1002
Practice Address - Fax:831-458-3690
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2018-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG35463207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G354630Medicaid
CA00G354630Medicare ID - Type Unspecified
A46366Medicare UPIN