Healthcare Provider Details

I. General information

NPI: 1346545530
Provider Name (Legal Business Name): ADRIAN A. BOSE MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2011
Last Update Date: 09/08/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

875 N. BREA BLVD.
BREA CA
92821-2606
US

IV. Provider business mailing address

1497 CASA GRANDE ST.
PASADENA CA
91104-3921
US

V. Phone/Fax

Practice location:
  • Phone: 714-529-6842
  • Fax: 714-256-1041
Mailing address:
  • Phone: 714-683-2970
  • Fax: 714-683-0925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberA89969
License Number StateCA

VIII. Authorized Official

Name: ADRIAN A. BOSE
Title or Position: PRESIDENT
Credential: MD
Phone: 714-683-2970