MEDICARE: DR. RICHARD S ROSE M.D.

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	G21963	CA

General Provider Information

NPI Number	:	1033206552
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RICHARD S ROSE M.D.

Provider Business Mailing Address
First Line	:	1101 OCEAN RIDGE CT
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-6466
Country	:	US
Telephone Number	:	352-445-2638
Fax Number	:

Provider Business Practice Location Address
First Line	:	1101 OCEAN RIDGE CT
Second Line	:
City	:	OCEANSIDE
State	:	CA
Zip	:	92056-6466
Country	:	US
Telephone Number	:	352-445-2638
Fax Number	:

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

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	12/21/2022

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