MEDICARE: PERRY ROSEN

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	235Z00000X	Speech-Language Pathologist	SP5183	CA

General Provider Information

NPI Number	:	1336225820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERRY ROSEN

Provider Business Mailing Address
First Line	:	7510 CLAIREMONT MESA BLVD
Second Line	:	SUITE 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1539
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7510 CLAIREMONT MESA BLVD
Second Line	:	SUITE 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92111-1539
Country	:	US
Telephone Number	:	858-277-2277
Fax Number	:

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

Provider Enumeration Date	:	10/27/2006
Last Update Date	:	07/08/2007

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Directions to “ PERRY ROSEN ” Practice Location

Language	Start Address	Practice Location

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