Healthcare Provider Details

I. General information

NPI: 1558560664
Provider Name (Legal Business Name): OREN ROSENBERG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 02/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

513 PARNASSUS AVE RM S-380
SAN FRANCISCO CA
94143-0654
US

IV. Provider business mailing address

513 PARNASSUS AVE RM S-380
SAN FRANCISCO CA
94143-0654
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2626
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number232389
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: