Healthcare Provider Details

I. General information

NPI: 1831188465
Provider Name (Legal Business Name): ERIC THOMAS ROSENTHAL PHD, SCM, CGC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3855 HEALTH SCIENCES DR., MC 0658 MOORES UCSD CANCER CENTER
LA JOLLA CA
92093-0658
US

IV. Provider business mailing address

3855 HEALTH SCIENCES DR., MC 0658 MOORES UCSD CANCER CENTER
LA JOLLA CA
92093-0658
US

V. Phone/Fax

Practice location:
  • Phone: 858-822-2124
  • Fax: 858-534-4813
Mailing address:
  • Phone: 858-822-2124
  • Fax: 858-534-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: