Provider Demographics
NPI:1104965425
Name:ROSEN, DAVID (MA)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2226 E RIO VERDE DR
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91791-2067
Mailing Address - Country:US
Mailing Address - Phone:626-332-1367
Mailing Address - Fax:626-332-0857
Practice Address - Street 1:2226 E RIO VERDE DR
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91791-2067
Practice Address - Country:US
Practice Address - Phone:626-332-1367
Practice Address - Fax:626-332-0857
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-05
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47455106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist