Provider Demographics
NPI:1861612772
Name:EAPEN, ROSE J (MD)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:J
Last Name:EAPEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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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 1:2809 N SEPULVEDA BLVD
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2727
Practice Address - Country:US
Practice Address - Phone:424-218-6073
Practice Address - Fax:424-226-3064
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-26
Last Update Date:2020-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG154556207Y00000X, 207YP0228X, 207YS0012X, 207YX0602X, 207YX0901X, 207YX0905X
NC2012-00236207YX0905X, 207YP0228X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
No207YX0901XAllopathic & Osteopathic PhysiciansOtolaryngologyOtology & Neurotology
No207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery