Provider Demographics
NPI:1194914234
Name:GILBERT ROSALES,M.D.,INC.
Entity type:Organization
Organization Name:GILBERT ROSALES,M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:GILBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSALES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-897-2164
Mailing Address - Street 1:13711 VAN NUYS BLVD SUITE 1
Mailing Address - Street 2:
Mailing Address - City:PACOIMA
Mailing Address - State:CA
Mailing Address - Zip Code:91331-3056
Mailing Address - Country:US
Mailing Address - Phone:818-897-2164
Mailing Address - Fax:818-890-9614
Practice Address - Street 1:13711 VAN NUYS BLVD SUITE 1
Practice Address - Street 2:
Practice Address - City:PACOIMA
Practice Address - State:CA
Practice Address - Zip Code:91331-3056
Practice Address - Country:US
Practice Address - Phone:818-897-2164
Practice Address - Fax:818-890-9614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-15
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53868261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16558Medicare PIN