Healthcare Provider Details

I. General information

NPI: 1295904936
Provider Name (Legal Business Name): MOORPARK FAMILY MEDICINE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2008
Last Update Date: 02/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 SCIENCE DR SUITE #190
MOORPARK CA
93021-2094
US

IV. Provider business mailing address

301 SCIENCE DR SUITE #190
MOORPARK CA
93021-2094
US

V. Phone/Fax

Practice location:
  • Phone: 805-531-9400
  • Fax: 805-531-9499
Mailing address:
  • Phone: 805-531-9400
  • Fax: 805-531-9499

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JONATHAN ANDREW ROSAASEN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 909-648-4004