MEDICARE: DR. MARIO ROSENBERG 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	174400000X	Specialist	A30941	CA

General Provider Information

NPI Number	:	1982635264
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIO ROSENBERG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 11439
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90213-4439
Country	:	US
Telephone Number	:	310-666-0840
Fax Number	:	310-275-4334

Provider Business Practice Location Address
First Line	:	9001 WILSHIRE BLVD STE 100
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1840
Country	:	US
Telephone Number	:	310-429-6854
Fax Number	:	310-275-4334

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

Provider Enumeration Date	:	07/05/2006
Last Update Date	:	06/22/2011

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