Healthcare Provider Details

I. General information

NPI: 1518144989
Provider Name (Legal Business Name): RICHARD A. ROSENBERG DPM INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/28/2008
Last Update Date: 02/05/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3300 E SOUTH ST ST 306
LAKEWOOD CA
90805-4549
US

IV. Provider business mailing address

3300 E SOUTH ST ST 306
LAKEWOOD CA
90805-4549
US

V. Phone/Fax

Practice location:
  • Phone: 562-633-5881
  • Fax: 562-633-3646
Mailing address:
  • Phone: 562-633-5881
  • Fax: 562-633-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BC3200X
TaxonomyCustomized Equipment (DME)
License NumberE2466
License Number StateCA

VIII. Authorized Official

Name: RICHARD ARTHUR ROSENBERG
Title or Position: OWNER
Credential: DPM
Phone: 562-633-5881