Provider Demographics
NPI:1134399173
Name:GOROSPE, CONRAD (MD)
Entity type:Individual
Prefix:DR
First Name:CONRAD
Middle Name:
Last Name:GOROSPE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18800 AMAR RD
Mailing Address - Street 2:B-9
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-4166
Mailing Address - Country:US
Mailing Address - Phone:626-839-4696
Mailing Address - Fax:626-965-8606
Practice Address - Street 1:18800 AMAR RD
Practice Address - Street 2:B-9
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-4166
Practice Address - Country:US
Practice Address - Phone:626-839-4696
Practice Address - Fax:626-965-8606
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39505207ZC0006X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZC0006XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG39505OtherMEDICAL LICENSE