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NPI Code Detail

MEDICARE: DR. WILLIAM N ROSE PH.D.

MEDICARE:  DR. WILLIAM N ROSE  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
1103TC0700XClinical PsychologistPSY23929CA

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1FU611AOTHERCAMEDICARE PTAN

General Provider Information

NPI Number : 1790089225
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. WILLIAM N ROSE PH.D.
Provider Business Mailing Address
First Line : 71687 HIGHWAY 111 STE 202
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-4515
Country : US
Telephone Number : 760-834-8770
Fax Number : 760-610-2693
Provider Business Practice Location Address
First Line : 71687 HIGHWAY 111 STE 202
Second Line :
City : RANCHO MIRAGE
State : CA
Zip : 92270-4515
Country : US
Telephone Number : 760-834-8770
Fax Number : 760-610-2693
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/23/2010
Last Update Date : 05/12/2015

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