Healthcare Provider Details

I. General information

NPI: 1285720292
Provider Name (Legal Business Name): TENA LA DAWN ROSSER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 08/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 SUNSET BOULEVARD M.S. #82
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

4650 SUNSET BOULEVARD M.S. #82
LOS ANGELES CA
90027-6062
US

V. Phone/Fax

Practice location:
  • Phone: 323-361-2940
  • Fax: 323-361-1109
Mailing address:
  • Phone: 323-361-2940
  • Fax: 323-361-1109

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0402X
TaxonomyNeurology with Special Qualifications in Child Neurology Physician
License NumberA88668
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: