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General NPI Number Information
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NPI Number | 1386225969
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Entity Type | Individual
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Provider Name | STACY ROSENBERG
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Gender | Female
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Dates
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Enumeration Date | 04/15/2021
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Last Update Date | 12/21/2024
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Provider Practice Location Address
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Address Line | 1710 CALLOWAY DR
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City | BAKERSFIELD
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State | CA
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Zip | 93312-2824
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Country | US
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Telephone | 661-515-1234
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Fax |
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Provider Business Mailing Address
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Address Line | 250 S HEATH RD APT 2097
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City | BAKERSFIELD
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State | CA
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Zip | 93314-4830
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Country | US
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Telephone | 585-739-2888
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 110965
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License Number State | CA
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