Provider Demographics
NPI:1053338624
Name:ROSE, STEVEN C (MD)
Entity type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:C
Last Name:ROSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MAIL CODE 8756
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-6607
Mailing Address - Fax:619-543-3781
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MAIL CODE 8756
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-6607
Practice Address - Fax:619-543-3781
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG712412085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Not Answered2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G712410Medicaid
CAE12524Medicare UPIN
CA00G712410Medicaid
CAWG71241CMedicare ID - Type Unspecified