Healthcare Provider Details

I. General information

NPI: 1821184946
Provider Name (Legal Business Name): STEVEN A ROSEBORO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1407 CRENSHAW BLVD STE 103
TORRANCE CA
90501-0424
US

IV. Provider business mailing address

1407 CRENSHAW BLVD STE 103
TORRANCE CA
90501-0424
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-6659
  • Fax: 310-320-6713
Mailing address:
  • Phone: 310-320-6659
  • Fax: 310-320-6713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2251X0800X
TaxonomyOrthopedic Physical Therapist
License NumberPT9920
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: