Individual
DR. RICHARD K.T. ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
9961 SIERRA AVE, MOB # 3, FONTANA, CA 92335-6720
(909) 427-4549
(909) 427-7086
Mailing address
9961 SIERRA AVE, MOB #3, FONTANA, CA 92335-6720
(909) 427-5611
(909) 427-7086
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
A71631
CA
207X00000X
Orthopaedic Surgery Physician
MD12937
HI
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
Primary
A71631
CA
207XS0114X
Adult Reconstructive Orthopaedic Surgery Physician
MD12937
HI
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
MD12937
HI
207XX0801X
Orthopaedic Trauma Physician
MD12937
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
084813001
DMERC
HI
01
—
247361
HMSA
HI
05
—
56682001
—
HI
01
—
MD12937-01
QUEENSHEALTHCARE/MDX
HI
Enumeration date
03/16/2006
Last updated
12/02/2021
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