Healthcare Provider Details

I. General information

NPI: 1245291723
Provider Name (Legal Business Name): MILTON ROLANDO DRACHENBERG M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2801 ATLANTIC AVE DEPARTMENT OF PATHOLOGY
LONG BEACH CA
90806-1701
US

IV. Provider business mailing address

2801 ATLANTIC AVE
LONG BEACH CA
90806-1737
US

V. Phone/Fax

Practice location:
  • Phone: 562-933-0828
  • Fax:
Mailing address:
  • Phone: 562-933-0828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZH0000X
TaxonomyHematology (Pathology) Physician
License NumberG077738
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: