Basic Information
| Provider Information | |||||||||
| NPI: | 1346545530 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADRIAN A. BOSE MD, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1497 CASA GRANDE ST. | ||||||||
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| City: | PASADENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 911043921 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7146832970 | ||||||||
| FaxNumber: | 7146830925 | ||||||||
| Practice Location | |||||||||
| Address1: | 875 N. BREA BLVD. | ||||||||
| Address2: | |||||||||
| City: | BREA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 928212606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145296842 | ||||||||
| FaxNumber: | 7142561041 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/19/2011 | ||||||||
| LastUpdateDate: | 09/08/2011 | ||||||||
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| AuthorizedOfficialLastName: | BOSE | ||||||||
| AuthorizedOfficialFirstName: | ADRIAN | ||||||||
| AuthorizedOfficialMiddleName: | A. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7146832970 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RC0200X | A89969 | CA | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine |
No ID Information.