Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G50480 | CA |
Y | 207ND0101X | MOHS-Micrographic Surgeon | G50480 | CA |
N | 207NS0135X | Procedural Dermatology | G50480 | CA |
NPI | 1265433072 |
---|---|
Provider Name | Dr. Robert Rosenberg |
First Address | Fullerton, CA 92835-2626 |
Second Address | Fullerton, CA 92835-2609 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/08/2005 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A51695 | (02) | CA |