Healthcare Provider Details

I. General information

NPI: 1326077660
Provider Name (Legal Business Name): HEATHER RENEE ROTH P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10261 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4502
US

IV. Provider business mailing address

10261 N 92ND ST STE 101
SCOTTSDALE AZ
85258-4502
US

V. Phone/Fax

Practice location:
  • Phone: 480-443-4437
  • Fax: 480-443-4525
Mailing address:
  • Phone: 480-443-4437
  • Fax: 480-443-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number2284
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: