Healthcare Provider Details

I. General information

NPI: 1720239288
Provider Name (Legal Business Name): DAVID B ROSENBLUM O D INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2008
Last Update Date: 03/17/2025
Certification Date: 03/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11805 SOUTH ST
CERRITOS CA
90703-6825
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: HEIDI QT PHAM-MURPHY
Title or Position: PRESIDENT
Credential: OD
Phone: 949-640-4473