MEDICARE: DR. SOPHIA JORDAN ROSENMOSS MD

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	390200000X	Student in an Organized Health Care Education/Training Program	344235	NY
2	207R00000X	Internal Medicine Physician	A190939	CA

General Provider Information

NPI Number	:	1992455166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SOPHIA JORDAN ROSENMOSS MD

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD SUITE 400
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-8344
Country	:	US
Telephone Number	:	310-301-8707
Fax Number	:

Provider Business Practice Location Address
First Line	:	200 UCLA MEDICAL PLZ STE 420
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-7417
Country	:	US
Telephone Number	:	310-206-6232
Fax Number	:

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

Provider Enumeration Date	:	03/28/2022
Last Update Date	:	05/04/2026

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