Provider Demographics
NPI:1619275203
Name:ROSENBERG, GARY JOEL (DO)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:JOEL
Last Name:ROSENBERG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11190 WARNER AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-4045
Mailing Address - Country:US
Mailing Address - Phone:714-241-0000
Mailing Address - Fax:714-241-7003
Practice Address - Street 1:11190 WARNER AVE STE 300
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-4045
Practice Address - Country:US
Practice Address - Phone:714-241-7000
Practice Address - Fax:714-241-7003
Is Sole Proprietor?:No
Enumeration Date:2011-03-04
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A15694207X00000X, 207XS0117X
MI5101020846207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery