Healthcare Provider Details

I. General information

NPI: 1689616617
Provider Name (Legal Business Name): GARY G ROSENGARTEN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 03/16/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 S SAN VICENTE BLVD SUITE 1101
LOS ANGELES CA
90048-4165
US

IV. Provider business mailing address

PO BOX 5333
TORRANCE CA
90510-5333
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-9619
  • Fax: 310-423-9610
Mailing address:
  • Phone: 310-329-2469
  • Fax: 310-329-0176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberPSY15819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: