Healthcare Provider Details

I. General information

NPI: 1538342464
Provider Name (Legal Business Name): CAROL SUE ROSENBERG R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2007
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3565 DEL AMO BLVD DEPARTMENT OF ENDOCRINOLOGY
TORRANCE CA
90503-1637
US

IV. Provider business mailing address

3565 DEL AMO BLVD DEPARTMENT OF ENDOCRINOLOGY
TORRANCE CA
90503-1637
US

V. Phone/Fax

Practice location:
  • Phone: 310-214-0811
  • Fax: 310-793-9531
Mailing address:
  • Phone: 310-214-0811
  • Fax: 310-793-9531

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number177
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SC2300X
TaxonomyChronic Care Clinical Nurse Specialist
License Number177
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number307042
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: