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NPI Code Detail

MEDICARE: DR. LISA ROSE AU.D.

MEDICARE: DR. LISA ROSE AU.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
1237600000XAudiologist-Hearing Aid FitterAU-3128CA

General Provider Information

NPI Number : 1851741151
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LISA ROSE AU.D.
Provider Business Mailing Address
First Line : 3600 BROADWAY
Second Line : #4 HEAD AND NECK SURGERY DEPARTMENT
City : OAKLAND
State : CA
Zip : 94611-5730
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3600 BROADWAY
Second Line : #4 HEAD AND NECK SURGERY DEPARTMENT
City : OAKLAND
State : CA
Zip : 94611-5730
Country : US
Telephone Number : 510-752-1889
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/16/2016
Last Update Date : 06/16/2016

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