Healthcare Provider Details

I. General information

NPI: 1235167107
Provider Name (Legal Business Name): SAMUEL R ROSENFELD M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 11/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 W STEWART DR SUITE 508
ORANGE CA
92868-3854
US

IV. Provider business mailing address

1310 W STEWART DR SUITE 508
ORANGE CA
92868-3854
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-2111
  • Fax: 714-633-5615
Mailing address:
  • Phone: 714-633-2111
  • Fax: 714-633-5615

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG37045
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207XP3100X
TaxonomyPediatric Orthopaedic Surgery Physician
License NumberG37045
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: