Healthcare Provider Details

I. General information

NPI: 1457342602
Provider Name (Legal Business Name): BETH MAXINE ROSENBERG PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2005
Last Update Date: 01/24/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14416 W MEEKER BLVD BLDG C
SUN CITY WEST AZ
85375-5284
US

IV. Provider business mailing address

13640 N PLAZA DEL RIO BLVD
PEORIA AZ
85381-4846
US

V. Phone/Fax

Practice location:
  • Phone: 623-583-5100
  • Fax: 623-583-5816
Mailing address:
  • Phone: 623-876-3800
  • Fax: 623-583-5816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number3002
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number3002
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: