| Doctor Name: | MR. LARRY ROSEN |
| NPI Number: | 1275510612 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | PA 13428 |
| Business Practice Address: | 11631 Victory Blvd N Hollywood, CA - 916063572 |
| Business Phone Number: | 8187648838 |
| Business Fax Number: | 8187643032 |
| Mailing Address: | 11631 Victory Blvd, #101 N HOLLYWOOD |
| State: | CA |
| Postal Code: | 916063572 |
| Phone Number: | 8187648838 |
| Fax Number: | 3102028995 |
| NPI Enumeration Date: | 12/28/2005 |
| NPI Last Update Date: | 05/07/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | PA 13428 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |