Provider Demographics
NPI:1265703854
Name:NICHOLAS E. ROSE, MD, INC.
Entity type:Organization
Organization Name:NICHOLAS E. ROSE, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:KAWADA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:949-270-0344
Mailing Address - Street 1:360 SAN MIGUEL DR STE 701
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-5927
Mailing Address - Country:US
Mailing Address - Phone:949-759-3600
Mailing Address - Fax:949-759-0282
Practice Address - Street 1:360 SAN MIGUEL DR STE 701
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-5927
Practice Address - Country:US
Practice Address - Phone:949-759-3600
Practice Address - Fax:949-759-0282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-13
Last Update Date:2012-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG74766174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG74766OtherMEDICARE PROVIDER
CAG47743Medicare UPIN