MEDICARE: MOORPARK FAMILY MEDICINE INC

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

General Provider Information

NPI Number	:	1295904936
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOORPARK FAMILY MEDICINE INC

Provider Business Mailing Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE #190
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-531-9400
Fax Number	:	805-531-9499

Provider Business Practice Location Address
First Line	:	301 SCIENCE DR
Second Line	:	SUITE #190
City	:	MOORPARK
State	:	CA
Zip	:	93021-2094
Country	:	US
Telephone Number	:	805-531-9400
Fax Number	:	805-531-9499

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JONATHAN ANDREW ROSAASEN
Credential	:	M.D.
Telephone Number	:	909-648-4004

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/06/2009

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