Healthcare Provider Details

I. General information

NPI: 1619390887
Provider Name (Legal Business Name): VANESSA SHANA ROTHHOLTZ MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/23/2014
Last Update Date: 06/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N CAMDEN DR STE 975
BEVERLY HILLS CA
90210
US

IV. Provider business mailing address

414 N CAMDEN DR STE 975
BEVERLY HILLS CA
90210-4541
US

V. Phone/Fax

Practice location:
  • Phone: 310-926-1573
  • Fax: 310-926-1563
Mailing address:
  • Phone: 818-850-0183
  • Fax: 310-201-9665

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number
License Number State

VIII. Authorized Official

Name: ARIEL WEEKS
Title or Position: BILLING MANAGER
Credential:
Phone: 818-850-0183