=====================================================
General NPI Number Information
=====================================================
NPI Number | 1942478631
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | C, ROSE RABINOV, M.D., INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/14/2008
-----------------------------------------------------
Last Update Date | 04/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3545 SAN DIMAS ST
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-1660
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-323-1947
-----------------------------------------------------
Fax | 661-323-1904
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3545 SAN DIMAS ST
-----------------------------------------------------
City | BAKERSFIELD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93301-1605
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 661-323-1947
-----------------------------------------------------
Fax | 661-323-1904
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | C. ROSE RABINOV
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 661-323-1947
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207Y00000X
-----------------------------------------------------
Taxonomy Name | Otolaryngology Physician
-----------------------------------------------------
License Number | G70060
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------