=====================================================
General NPI Number Information
=====================================================
NPI Number | 1205841988
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STEVEN ROSENBLATT M.D. A PROFESSIONAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/30/2006
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 16250 VENTURA BLVD SUITE 160
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91436-2204
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-990-6222
-----------------------------------------------------
Fax | 818-990-6217
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | P.O.BOX 260785
-----------------------------------------------------
City | ENCINO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-990-6222
-----------------------------------------------------
Fax | 818-990-6217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MEDICAL DIRECTOR
-----------------------------------------------------
Name | STEVEN L ROSENBLATT
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 818-990-6222
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | A53639
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------