Healthcare Provider Details

I. General information

NPI: 1821669300
Provider Name (Legal Business Name): ROBERTO ROIZENBLATT MD, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2021
Last Update Date: 05/08/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3828 SCHAUFELE AVE STE 360
LONG BEACH CA
90808-1793
US

IV. Provider business mailing address

2051 EDGEWOOD DR
SOUTH PASADENA CA
91030-3919
US

V. Phone/Fax

Practice location:
  • Phone: 562-444-8504
  • Fax: 562-363-0685
Mailing address:
  • Phone: 310-601-0603
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0107X
TaxonomyRetina Specialist (Ophthalmology) Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERTO ROIZENBLATT
Title or Position: OWNER
Credential: MD
Phone: 562-984-7024