Provider Demographics
NPI:1982723185
Name:RESCOBER, JOSELITO CASTOR (MD)
Entity Type:Individual
Prefix:
First Name:JOSELITO
Middle Name:CASTOR
Last Name:RESCOBER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11727 ANNAPOLIS DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-8238
Mailing Address - Country:US
Mailing Address - Phone:213-880-1277
Mailing Address - Fax:909-980-7779
Practice Address - Street 1:1300 N VERMONT AVE
Practice Address - Street 2:SUITE 309
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-6005
Practice Address - Country:US
Practice Address - Phone:213-880-1277
Practice Address - Fax:909-980-7779
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA29889208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A298890Medicaid
CA00A298890Medicaid
CAA84019Medicare UPIN