Healthcare Provider Details

I. General information

NPI: 1467690297
Provider Name (Legal Business Name): BENNET ROSS ROSENTHAL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2009
Last Update Date: 02/02/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

537 1ST ST
MANHATTAN BEACH CA
90266-6532
US

IV. Provider business mailing address

537 1ST ST
MANHATTAN BEACH CA
90266-6532
US

V. Phone/Fax

Practice location:
  • Phone: 310-372-5112
  • Fax:
Mailing address:
  • Phone: 310-372-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG43589
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: