Healthcare Provider Details

I. General information

NPI: 1548264013
Provider Name (Legal Business Name): CHARLES DAVID ROSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2005
Last Update Date: 04/30/2010
Certification Date:
Deactivation Date: 03/16/2006
Reactivation Date: 03/22/2006

III. Provider practice location address

101 THE CITY DR S
ORANGE CA
92868-3201
US

IV. Provider business mailing address

1601 N SEPULVEDA BLVD # 747
MANHATTAN BEACH CA
90266-5111
US

V. Phone/Fax

Practice location:
  • Phone: 714-534-0547
  • Fax: 714-456-7547
Mailing address:
  • Phone: 714-534-0547
  • Fax: 714-456-7547

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0117X
TaxonomyOrthopaedic Surgery of the Spine Physician
License NumberG53395
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: