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General NPI Number Information
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NPI Number | 1366389744
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Entity Type | Organization
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Legal Business Name | ROSE DERMATOLOGY MEDICAL CORPORATION
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Dates
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Enumeration Date | 05/02/2026
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Last Update Date | 05/02/2026
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Provider Practice Location Address
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Address Line | 360 SAN MIGUEL DR STE 600
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-7853
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Country | US
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Telephone | 949-229-0306
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Fax |
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Provider Business Mailing Address
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Address Line | 29911 NIGUEL RD UNIT 6358
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92607-2414
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Country | US
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Telephone | 949-229-0306
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Fax |
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Authorized Official
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Title or Position | OWNER, PHYSICIAN
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Name | DR. BLAIR ROSE
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Credential | MD
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Telephone | 949-229-0306
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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