Provider Demographics
NPI:1902905698
Name:ROSENTHAL, REGINA LORI (MD)
Entity type:Individual
Prefix:
First Name:REGINA
Middle Name:LORI
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3803 SOUTH BASCOM AVE
Mailing Address - Street 2:#206
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008
Mailing Address - Country:US
Mailing Address - Phone:408-559-4700
Mailing Address - Fax:408-377-6470
Practice Address - Street 1:3803 SOUTH BASCOM AVE
Practice Address - Street 2:#206
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008
Practice Address - Country:US
Practice Address - Phone:408-559-4700
Practice Address - Fax:408-377-6470
Is Sole Proprietor?:No
Enumeration Date:2006-09-21
Last Update Date:2012-08-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG49413208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
F06054Medicare UPIN