Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | G74766 | CA |
Y | 207XS0106X | Orthopaedic Hand Surgeon | G74766 | CA |
NPI | 1174550784 |
---|---|
Provider Name | Nicholas Elias Rose |
First Address | Newport Beach, CA 92660-7853 |
Second Address | Newport Beach, CA 92660-7853 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/06/2006 |
Last Update Date | 13/01/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G47743 | (02) | CA |