Provider Demographics
NPI:1548272727
Name:ROSENBAUM, STACEY (MD)
Entity type:Individual
Prefix:DR
First Name:STACEY
Middle Name:
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9663 SANTA MONICA BLVD
Mailing Address - Street 2:STE 676
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-4303
Mailing Address - Country:US
Mailing Address - Phone:310-860-1120
Mailing Address - Fax:310-860-1130
Practice Address - Street 1:421 N. RODEO DR
Practice Address - Street 2:PH 1
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4536
Practice Address - Country:US
Practice Address - Phone:310-432-6646
Practice Address - Fax:310-432-6647
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-13
Last Update Date:2017-01-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA79423207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology