Healthcare Provider Details

I. General information

NPI: 1851466288
Provider Name (Legal Business Name): HERSCHEL HAROLD ROSENBLUM DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2006
Last Update Date: 09/07/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CENTRAL AVE 302
GLENDALE CA
91204-4370
US

IV. Provider business mailing address

800 S CENTRAL AVE 302
GLENDALE CA
91204-4370
US

V. Phone/Fax

Practice location:
  • Phone: 818-240-5575
  • Fax: 818-240-1487
Mailing address:
  • Phone: 818-240-5575
  • Fax: 818-240-1487

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE1114
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: