Healthcare Provider Details

I. General information

NPI: 1013948959
Provider Name (Legal Business Name): EVAN G ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 02/21/2023
Certification Date: 02/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 UPPER RAGSDALE DR BLDG A
MONTEREY CA
93940-5736
US

IV. Provider business mailing address

100 WILSON RD STE 100
MONTEREY CA
93940-7885
US

V. Phone/Fax

Practice location:
  • Phone: 831-333-3040
  • Fax: 831-886-3639
Mailing address:
  • Phone: 818-649-1000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberME68557
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG143954
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: