Provider Demographics
NPI:1174688774
Name:ROSELINE DAUPHIN BAPTISTE MD INC
Entity Type:Organization
Organization Name:ROSELINE DAUPHIN BAPTISTE MD INC
Other - Org Name:ROSELINE DAUPHIN BAPTISTE MD
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PHYSICIAN /PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSELINE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DAUPHIN BAPTISTE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-282-3364
Mailing Address - Street 1:706 W BROADWAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91204-1032
Mailing Address - Country:US
Mailing Address - Phone:877-282-3364
Mailing Address - Fax:877-297-4486
Practice Address - Street 1:706 W BROADWAY
Practice Address - Street 2:SUITE 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1032
Practice Address - Country:US
Practice Address - Phone:877-282-3364
Practice Address - Fax:877-297-4486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG55469207V00000X, 261QM2500X, 261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G554690Medicaid
CAW21887OtherPTAN
CAW21887Medicare UPIN
CAD33349Medicare UPIN