Provider Demographics
NPI:1144811597
Name:ROSE J EAPEN, MD, PC
Entity type:Organization
Organization Name:ROSE J EAPEN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:J
Authorized Official - Last Name:EAPEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:424-218-6073
Mailing Address - Street 1:2711 N SEPULVEDA BLVD # 520
Mailing Address - Street 2:
Mailing Address - City:MANHATTAN BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90266-2725
Mailing Address - Country:US
Mailing Address - Phone:424-218-6073
Mailing Address - Fax:424-226-3064
Practice Address - Street 1:3655 LOMITA BLVD STE 300
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-3969
Practice Address - Country:US
Practice Address - Phone:424-218-6073
Practice Address - Fax:424-226-3064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-28
Last Update Date:2021-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty