Healthcare Provider Details

I. General information

NPI: 1447204250
Provider Name (Legal Business Name): MICHAEL C ROOSSIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

ONE HOAG DRIVE
NEWPORT BEACH AR
92663-4162
US

IV. Provider business mailing address

12060 ALZINA CT
LAS VEGAS NV
89138-1100
US

V. Phone/Fax

Practice location:
  • Phone: 949-764-5570
  • Fax: 949-263-0473
Mailing address:
  • Phone: 949-874-1276
  • Fax: 949-209-1951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberG52114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: