Healthcare Provider Details

I. General information

NPI: 1578890984
Provider Name (Legal Business Name): LINDA ROSEN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LINDA ROSEN-DEBOLD

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3672 KILAUEA AVE.
HONOLULU HI
96816
US

IV. Provider business mailing address

3672 KILAUEA AVE.
HONOLULU HI
96816
US

V. Phone/Fax

Practice location:
  • Phone: 808-733-8329
  • Fax: 808-733-8332
Mailing address:
  • Phone: 808-733-8329
  • Fax: 808-733-8332

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number4810
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: