Healthcare Provider Details

I. General information

NPI: 1265433072
Provider Name (Legal Business Name): ROBERT ROSENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2005
Last Update Date: 08/22/2023
Certification Date: 08/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2720 N HARBOR BLVD SUITE 210
FULLERTON CA
92835-2609
US

IV. Provider business mailing address

2720 N HARBOR BLVD STE 210
FULLERTON CA
92835-2626
US

V. Phone/Fax

Practice location:
  • Phone: 714-626-6310
  • Fax: 714-626-6320
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG50480
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG50480
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberG50480
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: