Healthcare Provider Details

I. General information

NPI: 1194838813
Provider Name (Legal Business Name): STEPHEN GARY ROSENBAUM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3838 CALIFORNIA ST SUITE111
SAN FRANCISCO CA
94118-1522
US

IV. Provider business mailing address

3838 CALIFORNIA ST SUITE111
SAN FRANCISCO CA
94118-1522
US

V. Phone/Fax

Practice location:
  • Phone: 415-666-1860
  • Fax: 415-666-0121
Mailing address:
  • Phone: 415-666-1860
  • Fax: 415-666-0121

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080A0000X
TaxonomyPediatric Adolescent Medicine Physician
License NumberG28250
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: