MEDICARE: DR. LESLIE B. ROSEN PH.D.

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	103T00000X	Psychologist	PSY 16532	CA

General Provider Information

NPI Number	:	1639241631
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LESLIE B. ROSEN PH.D.

Provider Business Mailing Address
First Line	:	2241 CANYONBACK RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1178
Country	:	US
Telephone Number	:	310-753-1908
Fax Number	:	310-471-9975

Provider Business Practice Location Address
First Line	:	2241 CANYONBACK RD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1178
Country	:	US
Telephone Number	:	310-753-1908
Fax Number	:	310-471-9975

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

Provider Enumeration Date	:	11/14/2006
Last Update Date	:	07/08/2007

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