Provider Demographics
NPI:1992722805
Name:ROISENZVIT, BERNARDO RODOLFO (MD)
Entity type:Individual
Prefix:DR
First Name:BERNARDO
Middle Name:RODOLFO
Last Name:ROISENZVIT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1425 MONTGOMERY RD
Mailing Address - Street 2:
Mailing Address - City:RED BLUFF
Mailing Address - State:CA
Mailing Address - Zip Code:96080-4605
Mailing Address - Country:US
Mailing Address - Phone:530-528-8600
Mailing Address - Fax:530-528-8612
Practice Address - Street 1:1425 MONTGOMERY RD
Practice Address - Street 2:
Practice Address - City:RED BLUFF
Practice Address - State:CA
Practice Address - Zip Code:96080-4605
Practice Address - Country:US
Practice Address - Phone:530-528-8600
Practice Address - Fax:530-528-8612
Is Sole Proprietor?:No
Enumeration Date:2006-07-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA60977208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG71245Medicare UPIN