Provider Demographics
NPI:1255345922
Name:ROSENSTEIN, WENDY SUSAN (MD)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:SUSAN
Last Name:ROSENSTEIN
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 1:10444 SANTA MONICA BLVD STE 304
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5057
Mailing Address - Country:US
Mailing Address - Phone:310-824-2886
Mailing Address - Fax:310-474-1868
Practice Address - Street 1:10444 SANTA MONICA BLVD STE 304
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5057
Practice Address - Country:US
Practice Address - Phone:310-824-2886
Practice Address - Fax:310-474-1868
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2014-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG489952084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G489950OtherBLUE SHIELD
CA00G489950OtherBLUE SHIELD
CAWG48995GMedicare ID - Type Unspecified
CA00G489950OtherMEDICAL