Provider Demographics
NPI:1750564506
Name:ROZALIA KOVELMAN, M.D., INC.
Entity type:Organization
Organization Name:ROZALIA KOVELMAN, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROZALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOVELMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:323-850-8282
Mailing Address - Street 1:7531 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE #202
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-6458
Mailing Address - Country:US
Mailing Address - Phone:323-850-8282
Mailing Address - Fax:323-850-1759
Practice Address - Street 1:7531 SANTA MONICA BLVD
Practice Address - Street 2:SUITE #202
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-6401
Practice Address - Country:US
Practice Address - Phone:323-850-8282
Practice Address - Fax:323-850-1759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-14
Last Update Date:2007-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41643174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty