Provider Demographics
NPI:1790850261
Name:J L ROSENTHAL MD INC
Entity Type:Organization
Organization Name:J L ROSENTHAL MD INC
Other - Org Name:JOHANNA LYNN ROSENTHAL MD
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHANNA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:ROSENTHAL MD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:714-577-8572
Mailing Address - Street 1:17021 E YORBA LINDA
Mailing Address - Street 2:#20
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-3742
Mailing Address - Country:US
Mailing Address - Phone:714-577-8572
Mailing Address - Fax:714-577-8528
Practice Address - Street 1:17021 E YORBA LINDA
Practice Address - Street 2:#20
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-3742
Practice Address - Country:US
Practice Address - Phone:714-577-8572
Practice Address - Fax:714-577-8528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG409762084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
A48415Medicare UPIN
G40976AMedicare ID - Type Unspecified