Provider Demographics
NPI:1144217589
Name:RABANERA, ROGELIO RAMOS (MD)
Entity Type:Individual
Prefix:DR
First Name:ROGELIO
Middle Name:RAMOS
Last Name:RABANERA
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 1:10230 ARTESIA BLVD
Mailing Address - Street 2:STE 104
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-6763
Mailing Address - Country:US
Mailing Address - Phone:562-867-2796
Mailing Address - Fax:562-867-0378
Practice Address - Street 1:10230 ARTESIA BLVD
Practice Address - Street 2:STE 104
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-6763
Practice Address - Country:US
Practice Address - Phone:562-867-2796
Practice Address - Fax:562-867-0378
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2010-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25752207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A257520Medicaid
CA00A257520Medicaid
A25752Medicare ID - Type Unspecified