MEDICARE: LEE S ROSEN 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	174400000X	Specialist	A49741	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	A49741	OTHER	CA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1346295870
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEE S ROSEN M.D.

Provider Business Mailing Address
First Line	:	4550 RUBIO AVE
Second Line	:
City	:	ENCINO
State	:	CA
Zip	:	91436-3202
Country	:	US
Telephone Number	:	818-783-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	2020 SANTA MONICA BLVD
Second Line	:	SUITE 510
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-2023
Country	:	US
Telephone Number	:	310-633-8400
Fax Number	:	310-633-8419

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

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	09/24/2012

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Directions to “ LEE S ROSEN M.D.” Practice Location

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