Provider Demographics
NPI:1245270966
Name:ROGOVE, HERBERT (DO)
Entity type:Individual
Prefix:
First Name:HERBERT
Middle Name:
Last Name:ROGOVE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E OJAI AVE # 626
Mailing Address - Street 2:
Mailing Address - City:OJAI
Mailing Address - State:CA
Mailing Address - Zip Code:93023-2736
Mailing Address - Country:US
Mailing Address - Phone:949-307-8288
Mailing Address - Fax:
Practice Address - Street 1:201 E OJAI AVE # 626
Practice Address - Street 2:
Practice Address - City:OJAI
Practice Address - State:CA
Practice Address - Zip Code:93023-2736
Practice Address - Country:US
Practice Address - Phone:949-307-8288
Practice Address - Fax:888-215-6279
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A4103207RC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0020A41030Medicaid
CA110232234OtherRR MEDICARE
CA0020A41030OtherBLUE SHIELD OF CA
CA0020A41030Medicaid
CA110232234OtherRR MEDICARE