Provider Demographics
NPI:1780624544
Name:ROGOFF, REBECCA S (DPM)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:S
Last Name:ROGOFF
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13132 STUDEBAKER RD
Mailing Address - Street 2:SUITE #10
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-2557
Mailing Address - Country:US
Mailing Address - Phone:562-651-1050
Mailing Address - Fax:562-868-2828
Practice Address - Street 1:13132 STUDEBAKER RD
Practice Address - Street 2:SUITE #10
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-2557
Practice Address - Country:US
Practice Address - Phone:562-651-1050
Practice Address - Fax:562-868-2828
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE4051213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
480022410OtherRAIL ROAD MEDICARE
000E40510OtherBLUE SHIELD
CA000E40510Medicaid
CAE4051OtherSTATE LICENSE
CA000E40510Medicaid
CA1208600001Medicare NSC
CAE4051OtherSTATE LICENSE