Provider Demographics
NPI:1740301142
Name:ROSENSTEIN, FRIDA (MD)
Entity type:Individual
Prefix:DR
First Name:FRIDA
Middle Name:
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 1:11447 DONA CECILIA DR
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-4233
Mailing Address - Country:US
Mailing Address - Phone:323-656-2082
Mailing Address - Fax:
Practice Address - Street 1:6850 VAN NUYS BLVD
Practice Address - Street 2:SUITE 210
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-4640
Practice Address - Country:US
Practice Address - Phone:818-901-9669
Practice Address - Fax:818-901-9344
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41476207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB50466Medicare UPIN
CAA41476Medicare ID - Type Unspecified