Healthcare Provider Details

I. General information

NPI: 1093790594
Provider Name (Legal Business Name): MARK ROSENBLATT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/07/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4860 Y ST
SACRAMENTO CA
95817-2307
US

IV. Provider business mailing address

4860 Y STREET TEI BUILDING
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-734-6602
  • Fax: 916-703-5076
Mailing address:
  • Phone: 916-734-6602
  • Fax: 916-703-5076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberA91585
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number246572
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: