Healthcare Provider Details

I. General information

NPI: 1760529176
Provider Name (Legal Business Name): ROGER G ANNABEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 03/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11705 SLATE AVE #200
RIVERSIDE CA
92505
US

IV. Provider business mailing address

4653 TORREY PINES DR
CHINO HILLS CA
91709-3388
US

V. Phone/Fax

Practice location:
  • Phone: 951-351-1364
  • Fax: 951-359-3748
Mailing address:
  • Phone: 909-994-5987
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA53036
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA53036
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberA53036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: