Provider Demographics
NPI:1437311131
Name:PALLIVATHUCAL, ROSALIND GEROGE (MD)
Entity Type:Individual
Prefix:
First Name:ROSALIND
Middle Name:GEROGE
Last Name:PALLIVATHUCAL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8100 CALIFORNIA AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-2469
Mailing Address - Country:US
Mailing Address - Phone:323-357-1000
Mailing Address - Fax:323-357-1001
Practice Address - Street 1:8100 CALIFORNIA AVE
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-2469
Practice Address - Country:US
Practice Address - Phone:323-357-1000
Practice Address - Fax:323-357-1001
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-25
Last Update Date:2008-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA43918207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A439182Medicaid
CAC35476Medicare UPIN
CA00A439182Medicaid