Healthcare Provider Details

I. General information

NPI: 1811315583
Provider Name (Legal Business Name): NATHAN ROJEK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2014
Last Update Date: 04/23/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 MEDICAL PLAZA DRIVE GOTTSCHALK MEDICAL PLAZA
IRVINE CA
92697-3017
US

IV. Provider business mailing address

118 MEDICAL SURGE I UC IRVINE DEPARTMENT OF DERMATOLOGY
IRVINE CA
92697-2400
US

V. Phone/Fax

Practice location:
  • Phone: 949-824-8600
  • Fax:
Mailing address:
  • Phone: 949-824-5515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA154167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: