Provider Demographics
NPI:1972576189
Name:ROSENBURG, JEFFREY M
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:ROSENBURG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2493 RUSSETT GLEN
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92029
Mailing Address - Country:US
Mailing Address - Phone:760-738-1715
Mailing Address - Fax:760-738-6439
Practice Address - Street 1:1955 CITRACADO PKWY
Practice Address - Street 2:SUITE 301
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92029-4110
Practice Address - Country:US
Practice Address - Phone:619-884-9222
Practice Address - Fax:760-738-6439
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG53269208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G532690Medicaid
CB212464OtherMEDICARE PTAN # CB212464
CA00G532690Medicaid