MEDICARE: MOLLY GOOD ROSSKNECHT D.O.

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	2084N0400X	Neurology Physician	5101018937	MI
2	2084N0400X	Neurology Physician	2OA14767	CA

General Provider Information

NPI Number	:	1205149309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MOLLY GOOD ROSSKNECHT D.O.

Provider Business Mailing Address
First Line	:	33 CREEK RD STE 340
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7705
Country	:	US
Telephone Number	:	949-861-8717
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 CREEK RD STE 340
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92604-7705
Country	:	US
Telephone Number	:	949-861-8717
Fax Number	:	949-861-8719

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

Provider Enumeration Date	:	07/16/2010
Last Update Date	:	01/02/2019

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Directions to “ MOLLY GOOD ROSSKNECHT D.O.” Practice Location

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