MEDICARE: DR. NICHOLAS ROZON 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	2084P0800X	Psychiatry Physician	A157428	CA

General Provider Information

NPI Number	:	1710410782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NICHOLAS ROZON M.D.

Provider Business Mailing Address
First Line	:	5455 WILSHIRE BLVD STE 903
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4236
Country	:	US
Telephone Number	:	844-867-8444
Fax Number	:

Provider Business Practice Location Address
First Line	:	5455 WILSHIRE BLVD STE 903
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-4236
Country	:	US
Telephone Number	:	844-867-8444
Fax Number	:

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

Provider Enumeration Date	:	04/06/2017
Last Update Date	:	11/08/2023

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