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General NPI Number Information
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NPI Number | 1982635264
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Entity Type | Individual
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Provider Name | MARIO ROSENBERG M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/05/2006
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Last Update Date | 06/22/2011
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Provider Practice Location Address
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Address Line | 9001 WILSHIRE BLVD STE 100
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City | BEVERLY HILLS
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State | CA
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Zip | 90211-1840
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Country | US
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Telephone | 310-429-6854
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Fax | 310-275-4334
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Provider Business Mailing Address
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Address Line | PO BOX 11439
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City | BEVERLY HILLS
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State | CA
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Zip | 90213-4439
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Country | US
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Telephone | 310-666-0840
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Fax | 310-275-4334
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | A30941
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License Number State | CA
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