Healthcare Provider Details

I. General information

NPI: 1720128374
Provider Name (Legal Business Name): DR. TORREY ROTHSTEIN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 08/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 SAN MATEO RD STE 104
HALF MOON BAY CA
94019-7172
US

IV. Provider business mailing address

210 SAN MATEO RD STE 104
HALF MOON BAY CA
94019-7172
US

V. Phone/Fax

Practice location:
  • Phone: 650-726-2144
  • Fax: 650-726-2726
Mailing address:
  • Phone: 650-726-2144
  • Fax: 650-726-2726

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number53860
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: