Provider Demographics
NPI:1689616617
Name:ROSENGARTEN, GARY G (PHD)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:G
Last Name:ROSENGARTEN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5333
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90510-5333
Mailing Address - Country:US
Mailing Address - Phone:310-329-2469
Mailing Address - Fax:310-329-0176
Practice Address - Street 1:444 S SAN VICENTE BLVD
Practice Address - Street 2:SUITE 1101
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4165
Practice Address - Country:US
Practice Address - Phone:310-423-9619
Practice Address - Fax:310-423-9610
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY158192084P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15819Medicare ID - Type Unspecified