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NPI Code Detail

MEDICARE: MARK ROLFSEN MD

MEDICARE: MARK ROLFSEN MD
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
1390200000XStudent in an Organized Health Care Education/Training Program
2207R00000XInternal Medicine PhysicianA164623CA

General Provider Information

NPI Number : 1578053856
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARK ROLFSEN MD
Provider Business Mailing Address
First Line : 315 S COAST HIGHWAY 101 STE U-173
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-3543
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 354 SANTA FE DR
Second Line :
City : ENCINITAS
State : CA
Zip : 92024-5182
Country : US
Telephone Number : 760-633-6501
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/13/2018
Last Update Date : 06/28/2021

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