Provider Demographics
NPI:1891947859
Name:ROLF N. GULBRANDSON, M.D., INC.
Entity Type:Organization
Organization Name:ROLF N. GULBRANDSON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLF
Authorized Official - Middle Name:N
Authorized Official - Last Name:GULBRANDSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-781-2500
Mailing Address - Street 1:5 MEDICAL PLAZA DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2865
Mailing Address - Country:US
Mailing Address - Phone:916-782-2500
Mailing Address - Fax:916-782-9424
Practice Address - Street 1:5 MEDICAL PLAZA DR
Practice Address - Street 2:SUITE 120
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2865
Practice Address - Country:US
Practice Address - Phone:916-782-2500
Practice Address - Fax:916-782-9424
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-21
Last Update Date:2008-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA25350174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ZZZ41979ZMedicare PIN