Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC014744 | CA |
NPI | 1245296680 |
---|---|
Provider Name | Ted D Rosen |
First Address | Modesto, CA 95355-4915 |
Second Address | Modesto, CA 95355-4915 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 07/01/2008 |