Provider Demographics
NPI:1134212681
Name:ROSENBERG, CHARLES DAVID (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:DAVID
Last Name:ROSENBERG
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 1:18672 FLORIDA ST.
Mailing Address - Street 2:SUITE 201
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648
Mailing Address - Country:US
Mailing Address - Phone:714-842-7796
Mailing Address - Fax:714-842-9206
Practice Address - Street 1:18672 FLORIDA ST.
Practice Address - Street 2:SUITE 201
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648
Practice Address - Country:US
Practice Address - Phone:714-842-7796
Practice Address - Fax:714-842-9206
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69930174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF57096Medicare UPIN