Healthcare Provider Details

I. General information

NPI: 1114352275
Provider Name (Legal Business Name): MICHAEL G. ROSENFELD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2013
Last Update Date: 09/09/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 W MONTECITO WAY
SAN DIEGO CA
92103-1263
US

IV. Provider business mailing address

1760 W MONTECITO WAY
SAN DIEGO CA
92103-1263
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-5858
  • Fax: 858-534-8180
Mailing address:
  • Phone: 858-534-5858
  • Fax: 858-534-8180

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License NumberG22006
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: