Provider Demographics
NPI:1144211889
Name:ROSENBLUM, DALE M (DPM)
Entity Type:Individual
Prefix:DR
First Name:DALE
Middle Name:M
Last Name:ROSENBLUM
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:704 N HARBOR BLVD
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92832-1520
Mailing Address - Country:US
Mailing Address - Phone:714-525-8282
Mailing Address - Fax:714-525-0141
Practice Address - Street 1:704 N HARBOR BLVD
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92832-1520
Practice Address - Country:US
Practice Address - Phone:714-525-8282
Practice Address - Fax:714-525-0141
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE1472213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT19108Medicare UPIN
CA0281760001Medicare NSC