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General NPI Number Information
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NPI Number | 1194914234
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Entity Type | Organization
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Legal Business Name | GILBERT ROSALES,M.D.,INC.
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Dates
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Enumeration Date | 10/15/2007
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Last Update Date | 06/20/2013
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Provider Practice Location Address
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Address Line | 13711 VAN NUYS BLVD SUITE 1
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City | PACOIMA
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State | CA
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Zip | 91331-3056
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Country | US
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Telephone | 818-897-2164
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Fax | 818-890-9614
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Provider Business Mailing Address
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Address Line | 13711 VAN NUYS BLVD SUITE 1
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City | PACOIMA
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State | CA
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Zip | 91331-3056
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Country | US
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Telephone | 818-897-2164
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Fax | 818-890-9614
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Authorized Official
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Title or Position | CEO
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Name | GILBERT ROSALES
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Credential | M.D.
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Telephone | 818-897-2164
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | A53868
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License Number State | CA
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