Healthcare Provider Details

I. General information

NPI: 1245473677
Provider Name (Legal Business Name): MARK C. ROTHMAN, M. D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 08/26/2023
Certification Date: 08/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR STE 102
BEVERLY HILLS CA
90210-4323
US

IV. Provider business mailing address

371 VAN NESS WAY STE 210
TORRANCE CA
90501-6297
US

V. Phone/Fax

Practice location:
  • Phone: 310-385-8819
  • Fax:
Mailing address:
  • Phone: 310-792-3914
  • Fax: 855-503-4977

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberG83051
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberG83051
License Number StateCA

VIII. Authorized Official

Name: MARK ROTHMAN
Title or Position: PRESIDENT/ SOLE OWNER
Credential:
Phone: 818-244-8200