MEDICARE: ROBERT ROSENBAUM

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	103TC0700X	Clinical Psychologist	PSY5771	CA

General Provider Information

NPI Number	:	1710012109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT ROSENBAUM

Provider Business Mailing Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 203
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-279-1476
Fax Number	:	562-279-0211

Provider Business Practice Location Address
First Line	:	1040 ELM AVE
Second Line	:	SUITE 203
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3264
Country	:	US
Telephone Number	:	562-279-1476
Fax Number	:	562-279-0211

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

Provider Enumeration Date	:	02/23/2007
Last Update Date	:	07/08/2007

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