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General NPI Number Information
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NPI Number | 1134983703
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Entity Type | Individual
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Provider Name | BENJAMIN ROSENBERG
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Gender | Male
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Dates
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Enumeration Date | 02/13/2024
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Last Update Date | 02/13/2024
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Provider Practice Location Address
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Address Line | 3826 GRAND VIEW BLVD UNIT 661264
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City | LOS ANGELES
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State | CA
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Zip | 90066-8259
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Country | US
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Telephone | 424-465-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 1285 FRANZ HALL #6558
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 408-306-8603
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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