| Doctor Name: | DR. MARC R ROSE |
| NPI Number: | 1770684938 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MD |
| License Number: | C37054 |
| Business Practice Address: | 3420 Bristol St Ste 700 Costa Mesa, CA - 926267137 |
| Business Phone Number: | 3102307400 |
| Business Fax Number: | 3102307440 |
| Mailing Address: | Po Box 26289, SANTA ANA |
| State: | CA |
| Postal Code: | 927996203 |
| Phone Number: | 3102307400 |
| Fax Number: | 3102307440 |
| NPI Enumeration Date: | 09/26/2006 |
| NPI Last Update Date: | 08/20/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | C37054 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |