Provider Demographics
NPI:1013337781
Name:ROSOFF, ERIC (MD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:ROSOFF
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 1:11980 SAN VICENTE BLVD STE 910
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-6607
Mailing Address - Country:US
Mailing Address - Phone:310-620-6002
Mailing Address - Fax:888-894-0883
Practice Address - Street 1:11980 SAN VICENTE BLVD STE 910
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-6607
Practice Address - Country:US
Practice Address - Phone:310-620-6002
Practice Address - Fax:888-894-0883
Is Sole Proprietor?:No
Enumeration Date:2014-04-22
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1560802084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry