Provider Demographics
NPI:1316969843
Name:ROSENTHAL, NEIL PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:NEIL
Middle Name:PAUL
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:17525 VENTURA BLVD.
Mailing Address - Street 2:SUITE 203.
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5109
Mailing Address - Country:US
Mailing Address - Phone:818-995-1175
Mailing Address - Fax:818-638-5762
Practice Address - Street 1:17525 VENTURA BLVD.
Practice Address - Street 2:SUITE 203.
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5109
Practice Address - Country:US
Practice Address - Phone:818-995-1175
Practice Address - Fax:818-638-5762
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC334412084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC33441OtherMEDICARE LICENSE
CA1093909384OtherMEDICARE ORG NPI
CAC33441OtherMEDICARE LICENSE