Individual
DR. FREDRIC ROBERT ROSENBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3650 E. SOUTH STREET, #306, LAKEWOOD, CA 90712
(310) 378-1915
(310) 378-6979
Mailing address
3650 E. SOUTH STREET, #306, LAKEWOOD, CA 90712
(310) 378-1915
(310) 378-6979
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
G21402
CA
207ND0101X
MOHS-Micrographic Surgery Physician
G21402
CA
207ND0900X
Dermatopathology Physician
G21402
CA
207NI0002X
Clinical & Laboratory Dermatological Immunology Physician
G21402
CA
207NP0225X
Pediatric Dermatology Physician
G21402
CA
207NS0135X
Procedural Dermatology Physician
G21402
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G214020
—
CA
01
—
4024334
AETNA
CA
01
—
G21402
STATE LICENSE
CA
01
—
ZZZ12556Z
BLUE SHIELD
CA
Enumeration date
01/10/2007
Last updated
10/12/2010
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