Healthcare Provider Details

I. General information

NPI: 1942370531
Provider Name (Legal Business Name): ROGELIO RABANERA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10230 E ARTESIA BLVD #104
BELLFLOWER CA
90706
US

IV. Provider business mailing address

10230 E ARTESIA BLVD #104
BELLFLOWER CA
90706
US

V. Phone/Fax

Practice location:
  • Phone: 562-867-2796
  • Fax: 562-867-0378
Mailing address:
  • Phone: 562-867-2796
  • Fax: 562-867-0378

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA25752
License Number StateCA

VIII. Authorized Official

Name: DR. ROGELIO RAMOS RABANERA
Title or Position: PRESIDENT PHYSICIAN
Credential: MD
Phone: 562-867-2796