Individual
BRENT SHANE ROSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3855 HEALTH SCIENCES DR, LA JOLLA, CA 92093-1503
(619) 341-3899
Mailing address
3855 HEALTH SCIENCES DR, LA JOLLA, CA 92093-1503
(619) 341-3899
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
248551
MA
2085R0001X
Radiation Oncology Physician
Primary
248551
MA
Other
Enumeration date
05/19/2011
Last updated
04/04/2016
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