MEDICARE: DR. JORDAN SCOTT ROSENTHAL D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	E3436	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	213E00000X	OTHER	CA	MEDICARE TYPE-

General Provider Information

NPI Number	:	1205894821
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JORDAN SCOTT ROSENTHAL D.P.M.

Provider Business Mailing Address
First Line	:	9100 SO SEPULVEDA BLVD
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4849
Country	:	US
Telephone Number	:	310-645-3338
Fax Number	:	310-645-0823

Provider Business Practice Location Address
First Line	:	9100 SO SEPULVEDA BLVD
Second Line	:	SUITE 100
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-4849
Country	:	US
Telephone Number	:	310-645-3338
Fax Number	:	310-645-0823

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	05/18/2011

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Directions to “ DR. JORDAN SCOTT ROSENTHAL D.P.M.” Practice Location

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