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General NPI Number Information
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NPI Number | 1003989872
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Entity Type | Individual
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Provider Name | JANE C ROSEN PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/17/2006
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 14547 VICTORY BLVD
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City | VAN NUYS
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State | CA
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Zip | 91411-1619
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Country | US
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Telephone | 818-997-3232
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Fax |
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Provider Business Mailing Address
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Address Line | 29085 OAK CREEK LN APT 701
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City | AGOURA HILLS
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State | CA
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Zip | 91301-6433
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Country | US
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Telephone | 410-456-7622
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 64950
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | C0000595
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License Number State | MD
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