Healthcare Provider Details

I. General information

NPI: 1578583258
Provider Name (Legal Business Name): GARY IVAN ROSENTHAL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 SAND ISLAND ACCESS ROAD
HONOLULU HI
96819
US

IV. Provider business mailing address

PO BOX 1874
HONOLULU HI
96805-1874
US

V. Phone/Fax

Practice location:
  • Phone: 808-842-2930
  • Fax:
Mailing address:
  • Phone: 808-595-7437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License NumberG50325
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: