Healthcare Provider Details

I. General information

NPI: 1750952248
Provider Name (Legal Business Name): MR. NICHOLAS ANTHONY ROSENER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2021
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

98 BOSWORTH ST
SAN FRANCISCO CA
94112-1002
US

IV. Provider business mailing address

233 ROCKWOOD DR
SOUTH SAN FRANCISCO CA
94080-5840
US

V. Phone/Fax

Practice location:
  • Phone: 415-551-0975
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: