Individual
STACY R ROSENBLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
3319 STATE ROAD 7, STE 110, WELLINGTON, FL 33449-8094
(561) 784-7884
(561) 784-7884
Mailing address
PO BOX 844492, LOS ANGELES, CA 90084-4492
(480) 948-8400
(480) 948-8401
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
006121
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
835513
—
AZ
Enumeration date
07/26/2013
Last updated
10/27/2016
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