Provider Demographics
NPI:1881795458
Name:SHERMAN P ROSOVE, MD, A PROFESSIONAL
Entity type:Organization
Organization Name:SHERMAN P ROSOVE, MD, A PROFESSIONAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHERMAN
Authorized Official - Middle Name:P
Authorized Official - Last Name:ROSOVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-250-0235
Mailing Address - Street 1:25050 AVENUE KEARNY
Mailing Address - Street 2:SUITE 208
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-1255
Mailing Address - Country:US
Mailing Address - Phone:661-430-0940
Mailing Address - Fax:661-295-0862
Practice Address - Street 1:1663 BEVERLY BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5747
Practice Address - Country:US
Practice Address - Phone:213-250-0235
Practice Address - Fax:213-250-0439
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-26
Last Update Date:2014-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC25993207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110095099OtherPRES RAILROAD MCARE ID#
CAC25993OtherPRES. MEDICAL LICENSE#
CAA33017Medicare UPIN
CAC25993Medicare ID - Type UnspecifiedPRES. MEDICARE ID#
CA00C259930Medicaid
CAC25993Medicare ID - Type UnspecifiedPRES. MEDICARE ID#