Provider Demographics
NPI:1639101066
Name:GILMAN KLINE, ROSE DIANE (DPM)
Entity Type:Individual
Prefix:DR
First Name:ROSE
Middle Name:DIANE
Last Name:GILMAN KLINE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:DR
Other - First Name:ROSE
Other - Middle Name:DIANE
Other - Last Name:GILMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 972
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91365-0972
Mailing Address - Country:US
Mailing Address - Phone:818-905-1000
Mailing Address - Fax:818-342-1609
Practice Address - Street 1:17777 VENTURA BLVD
Practice Address - Street 2:230
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3736
Practice Address - Country:US
Practice Address - Phone:818-905-1000
Practice Address - Fax:818-436-2467
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2775213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E27750Medicaid
CA000E27750Medicaid
CADY716ZMedicare PIN