Healthcare Provider Details

I. General information

NPI: 1801910294
Provider Name (Legal Business Name): JAMES ETHAN ROSENBERG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14545 SHERMAN CIRCLE
VAN NUYS CA
91405
US

IV. Provider business mailing address

21900 BURBANK BLVD 3RD FLOOR
WOODLAND HILLS CA
91367
US

V. Phone/Fax

Practice location:
  • Phone: 818-901-4854
  • Fax: 818-908-4995
Mailing address:
  • Phone: 818-865-2978
  • Fax: 818-698-6400

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG669801
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: