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General NPI Number Information
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NPI Number | 1447204250
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Entity Type | Individual
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Provider Name | MICHAEL C ROOSSIN M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 06/20/2025
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Provider Practice Location Address
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Address Line | ONE HOAG DRIVE
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City | NEWPORT BEACH
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State | AR
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Zip | 92663-4162
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Country | US
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Telephone | 949-764-5570
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Fax | 949-263-0473
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Provider Business Mailing Address
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Address Line | 12060 ALZINA CT
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City | LAS VEGAS
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State | NV
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Zip | 89138-1100
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Country | US
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Telephone | 949-874-1276
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Fax | 949-209-1951
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | G52114
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License Number State | CA
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