MEDICARE: DR. BARBARA ROSEN PH.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	103TC0700X	Clinical Psychologist	PSY4269	CA

General Provider Information

NPI Number	:	1740285600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA ROSEN PH.D.

Provider Business Mailing Address
First Line	:	17452 IRVINE BLVD
Second Line	:	STE 214
City	:	TUSTIN
State	:	CA
Zip	:	92780-3031
Country	:	US
Telephone Number	:	714-731-6111
Fax Number	:	714-730-4709

Provider Business Practice Location Address
First Line	:	17452 IRVINE BLVD
Second Line	:	STE 214
City	:	TUSTIN
State	:	CA
Zip	:	92780-3031
Country	:	US
Telephone Number	:	714-731-6111
Fax Number	:	714-730-4709

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

Provider Enumeration Date	:	06/16/2005
Last Update Date	:	01/07/2009

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