1013948959 NPI number — EVAN G ROSEN M.D.

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013948959 NPI number — EVAN G ROSEN M.D.

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

ROSEN

Provider First Name:

EVAN

Provider Middle Name:

G

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

M.D.

Provider Gender Code:

M

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1013948959

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

02/21/2023

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

100 WILSON RD STE 100

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

MONTEREY

Provider Business Mailing Address State Name:

CA

Provider Business Mailing Address Postal Code:

93940-7885

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

818-649-1000

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

2 UPPER RAGSDALE DR BLDG A

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

MONTEREY

Provider Business Practice Location Address State Name:

CA

Provider Business Practice Location Address Postal Code:

93940-5736

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

831-333-3040

Provider Business Practice Location Address Fax Number:

831-886-3639

Provider Enumeration Date:

07/06/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208800000X , with the licence number:  ME68557 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208800000X , with the licence number: G143954 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: P988893 . This is a "FREEDOM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 16933 . This is a "WELLCARE" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: S817401 . This is a "CAREPLUS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 5898115 . This is a "AETNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 203920 . This is a "AVMED" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 3781724 . This is a "CIGNA" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 5301 . This is a "DIMENSION HEALTH PPO" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: P968835 . This is a "OPTIMUM" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
• Identifier: 27150 . This is a "BCBS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".