Healthcare Provider Details

I. General information

NPI: 1073387825
Provider Name (Legal Business Name): ROBERT ROSETT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2023
Last Update Date: 11/13/2023
Certification Date: 11/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15061 SPRINGDALE ST STE 110
HUNTINGTON BEACH CA
92649-1103
US

IV. Provider business mailing address

6236 COLGATE AVE
LOS ANGELES CA
90036-3144
US

V. Phone/Fax

Practice location:
  • Phone: 831-262-2969
  • Fax: 833-563-2266
Mailing address:
  • Phone: 650-223-4208
  • Fax: 833-563-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code174N00000X
TaxonomyLactation Consultant (Non-RN)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT ROSETT
Title or Position: MD
Credential: MD
Phone: 831-262-2969