Healthcare Provider Details

I. General information

NPI: 1497275515
Provider Name (Legal Business Name): SCOTT FRANCIS ROSENFIELD IDC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/20/2017
Last Update Date: 06/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL SPECIAL WARFARE UNIT TWO UNIT 30401
APO AE
09107-0401
US

IV. Provider business mailing address

NAVAL SPECIAL WARFARE UNIT TWO UNIT 30401
APO AE
09107-0401
US

V. Phone/Fax

Practice location:
  • Phone: 619-787-1569
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: