Provider Demographics
NPI:1205841988
Name:STEVEN ROSENBLATT M.D. A PROFESSIONAL CORP
Entity Type:Organization
Organization Name:STEVEN ROSENBLATT M.D. A PROFESSIONAL CORP
Other - Org Name:ENCINO MEDICAL WELLNESS
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSENBLATT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-990-6222
Mailing Address - Street 1:P.O.BOX 260785
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426
Mailing Address - Country:US
Mailing Address - Phone:818-990-6222
Mailing Address - Fax:818-990-6217
Practice Address - Street 1:16250 VENTURA BLVD
Practice Address - Street 2:SUITE 160
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2204
Practice Address - Country:US
Practice Address - Phone:818-990-6222
Practice Address - Fax:818-990-6217
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-30
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53639174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF96355Medicare UPIN