Organization
ROSE MEDICAL GROUP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MICHAEL R. ROSE G33914 (PRESIDENT)
(323) 221-6121
Entity
Organization
Contact information
Practice address
2400 N BROADWAY, LOS ANGELES, CA 90031-2219
(323) 221-6121
(323) 221-6120
Mailing address
PO BOX 31250, LOS ANGELES, CA 90031-0250
(323) 221-6121
(323) 221-6120
Taxonomy
Speciality
Code
Description
License number
State
156FX1100X
Ophthalmic Technician/Technologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0014310
—
CA
Enumeration date
09/26/2006
Last updated
04/24/2008
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