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General NPI Number Information
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NPI Number | 1619117835
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Entity Type | Organization
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Legal Business Name | RANDY ROSEN MD A PC & NICOLAS S FULLER MD INC JOINT VENTURE
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Dates
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Enumeration Date | 02/27/2009
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Last Update Date | 05/06/2009
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Provider Practice Location Address
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Address Line | 120 S SPALDING DR SUITE 301
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1800
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Country | US
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Telephone | 310-385-7755
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 893520
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City | TEMECULA
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State | CA
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Zip | 92589-3520
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Country | US
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Telephone | 310-385-7755
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. RANDY ROSEN
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Credential | M.D.
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Telephone | 310-440-3131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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