1972576189 NPI number — DR. JEFFREY M ROSENBURG

Table of content: DR. JEFFREY M ROSENBURG (NPI 1972576189)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972576189 NPI number — DR. JEFFREY M ROSENBURG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROSENBURG
Provider First Name:
JEFFREY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
M

Provider's Other Name Information

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 Information

NPI Number:
1972576189
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2493 RUSSETT GLEN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ESCONDIDO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-738-1715
Provider Business Mailing Address Fax Number:
760-738-6439

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1955 CITRACADO PKWY
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
ESCONDIDO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92029-4110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-884-9222
Provider Business Practice Location Address Fax Number:
760-738-6439
Provider Enumeration Date:
02/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208G00000X , with the licence number:  G53269 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00G532690 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: CB212464 . This is a "MEDICARE PTAN # CB212464" identifier . This identifiers is of the category "OTHER".




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