MEDICARE: DR. NANCY LEE ROSSER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	G15761	CA

General Provider Information

NPI Number	:	1033201363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY LEE ROSSER MD

Provider Business Mailing Address
First Line	:	200 S BARRINGTON AVE
Second Line	:	1907
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-7939
Country	:	US
Telephone Number	:	310-472-9000
Fax Number	:	310-476-0503

Provider Business Practice Location Address
First Line	:	200 S. BARRINGTON AVE.
Second Line	:	1907
City	:	LOS ANGELES
State	:	CA
Zip	:	90094
Country	:	US
Telephone Number	:	310-472-9000
Fax Number	:	310-476-0503

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2006
Last Update Date	:	07/17/2014

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