MEDICARE: NATHANIEL G. ROSE, M.D., A.P.C.

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	207Q00000X	Family Medicine Physician	G16726	CA

General Provider Information

NPI Number	:	1275689994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATHANIEL G. ROSE, M.D., A.P.C.

Provider Business Mailing Address
First Line	:	4490 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4292
Country	:	US
Telephone Number	:	858-274-9116
Fax Number	:	858-490-5321

Provider Business Practice Location Address
First Line	:	4490 FANUEL ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-4292
Country	:	US
Telephone Number	:	858-274-9116
Fax Number	:	858-490-5321

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	LALO AVILA
Credential	:
Telephone Number	:	858-274-9116

Provider Enumeration Date	:	01/26/2007
Last Update Date	:	10/11/2007

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