Healthcare Provider Details

I. General information

NPI: 1376643395
Provider Name (Legal Business Name): DAVID B ROSENBLUM O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

326 LOS CERRITOS MALL
CERRITOS CA
90703-5425
US

IV. Provider business mailing address

11805 SOUTH ST
CERRITOS CA
90703-6825
US

V. Phone/Fax

Practice location:
  • Phone: 562-860-4475
  • Fax: 562-924-3526
Mailing address:
  • Phone: 562-860-4475
  • Fax: 562-924-3526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number10235T
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: