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General NPI Number Information
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NPI Number | 1003850421
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Entity Type | Individual
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Provider Name | JOHN GEORGE ROSENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/15/2006
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Last Update Date | 12/08/2021
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Provider Practice Location Address
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Address Line | 2417 CARLETON ST
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City | BERKELEY
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State | CA
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Zip | 94704-3310
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Country | US
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Telephone | 510-984-7811
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Fax |
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Provider Business Mailing Address
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Address Line | 2893 BUENA VISTA WAY
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City | BERKELEY
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State | CA
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Zip | 94708-2015
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Country | US
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Telephone | 510-984-7811
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G51461
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License Number State | CA
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