Healthcare Provider Details

I. General information

NPI: 1891094207
Provider Name (Legal Business Name): MARTIN GIDEON ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2011
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11370 ANDERSON ST STE 2100
LOMA LINDA CA
92354-3450
US

IV. Provider business mailing address

11370 ANDERSON ST
LOMA LINDA CA
92354-3450
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-2822
  • Fax:
Mailing address:
  • Phone: 909-558-2822
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License Number266125
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number266125
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberA171075
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2086S0102X
TaxonomySurgical Critical Care Physician
License NumberA171075
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License Number266125
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: