Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 25621 | CA |
Y | 213EG0000X | General Practice | 25621 | CA |
N | 1223G0001X | General Practice | 26479 | CA |
N | 213EG0000X | General Practice | 26479 | CA |
N | 1223G0001X | General Practice | 32632 | CA |
N | 213EG0000X | General Practice | 32632 | CA |
N | 1223P0106X | Oral and Maxillofacial Pathology | 18262 | CA |
N | 1223P0300X | Periodontist | 46393 | CA |
NPI | 1275572539 |
---|---|
Provider Name | Dr. Joseph R Rosenberg |
First Address | San Gabriel, CA 91775-1936 |
Second Address | San Gabriel, CA 91775-1936 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2006 |
Last Update Date | 06/12/2007 |