Healthcare Provider Details

I. General information

NPI: 1326341322
Provider Name (Legal Business Name): JESSICA LAUREN ROSENBLUM PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2010
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 S PRICE RD
TEMPE AZ
85282-7528
US

IV. Provider business mailing address

6832 E BROWN RD
MESA AZ
85207-3755
US

V. Phone/Fax

Practice location:
  • Phone: 480-830-8333
  • Fax: 480-830-8390
Mailing address:
  • Phone: 480-830-8333
  • Fax: 480-830-8390

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number4763
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: