MEDICARE: AMY LYNNE ROSENBAUM MSN, NP

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	363LF0000X	Family Nurse Practitioner	504418	CA

General Provider Information

NPI Number	:	1790906196
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY LYNNE ROSENBAUM MSN, NP

Provider Business Mailing Address
First Line	:	823 GATEWAY CENTER WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-4541
Country	:	US
Telephone Number	:	619-515-2323
Fax Number	:	619-906-4564

Provider Business Practice Location Address
First Line	:	1809 NATIONAL AVENUE
Second Line	:	LOGAN HEIGHTS FAMILY HEALTH CENTERS
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-3538
Country	:	US
Telephone Number	:	619-515-2300
Fax Number	:	619-234-2447

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

Provider Enumeration Date	:	05/01/2007
Last Update Date	:	02/01/2022

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