Healthcare Provider Details

I. General information

NPI: 1699862102
Provider Name (Legal Business Name): PAUL DAVID ROSENBLIT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18821 DELAWARE ST SUITE 202
HUNTINGTON BEACH CA
92648-1926
US

IV. Provider business mailing address

18821 DELAWARE ST SUITE 202
HUNTINGTON BEACH CA
92648-1926
US

V. Phone/Fax

Practice location:
  • Phone: 714-375-5572
  • Fax: 714-375-5575
Mailing address:
  • Phone: 714-375-5572
  • Fax: 714-375-5575

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberA39224
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA039224
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: