MEDICARE: ROSALIE ANNE BLOOMBERG-RISSMAN L.C.S.W.

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	1041C0700X	Clinical Social Worker	LCS 24627	CA

General Provider Information

NPI Number	:	1215195425
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSALIE ANNE BLOOMBERG-RISSMAN L.C.S.W.

Provider Business Mailing Address
First Line	:	3003 HEALTH CENTER DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-2700
Country	:	US
Telephone Number	:	858-939-4129
Fax Number	:	858-939-4248

Provider Business Practice Location Address
First Line	:	325 W WASHINGTON ST STE 3016
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1946
Country	:	US
Telephone Number	:	619-324-9830
Fax Number	:

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

Provider Enumeration Date	:	05/26/2008
Last Update Date	:	06/28/2023

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