Raphael D. Rose, PH.D.

Primary specialty

Cognitive & Behavioral PsychologistTaxonomy code 103TB0200X

License

21412 Issued in CA

Practice address

11022 Santa Monica Blvd Ste 250
Los Angeles, CA 90025-7573

Phone

(310) 882-8697

NPI assigned

Feb 10, 2009

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Philosophy

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1234224000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1521244800000",
    "number": "1689813941",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11022 SANTA MONICA BLVD STE 250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257573",
            "telephone_number": "310-882-8697"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11022 SANTA MONICA BLVD STE 250",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257573",
            "telephone_number": "310-882-8697"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9171 Wilshire Blvd",
            "address_2": "Penthouse #2",
            "address_purpose": "LOCATION",
            "city": "Beverly Hills",
            "state": "CA",
            "postal_code": "902105530",
            "country_code": "US",
            "telephone_number": "310-882-8697",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "ROSE",
        "first_name": "RAPHAEL",
        "middle_name": "D.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2009-02-10",
        "last_updated": "2018-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "21412",
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "21412",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Krista Nicole Rose, PHD
• Leslie Rose
• Linda Rose, M.A., LMFT
• Michael R Rose, MD
• Millicent Shungu Rose, LMFT
• Shira Rachel Rose
• Thomas A Rose, OD
• Victoria Rose
• Victoria J Rose II, M.A.
• Rose's Agency Home Care

• Cognitive & Behavioral Psychologist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Cognitive & Behavioral Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.