Provider Demographics
NPI:1699862102
Name:ROSENBLIT, PAUL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:DAVID
Last Name:ROSENBLIT
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 1:18821 DELAWARE ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-1926
Mailing Address - Country:US
Mailing Address - Phone:714-375-5572
Mailing Address - Fax:714-375-5575
Practice Address - Street 1:18821 DELAWARE ST
Practice Address - Street 2:SUITE 202
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-1926
Practice Address - Country:US
Practice Address - Phone:714-375-5572
Practice Address - Fax:714-375-5575
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39224207RE0101X
CAA039224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A392240Medicaid
CAA39224Medicare ID - Type Unspecified
CAA85262Medicare UPIN