Healthcare Provider Details

I. General information

NPI: 1649371261
Provider Name (Legal Business Name): ELLEN LERNER ROTHMAN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/26/2006
Last Update Date: 01/30/2026
Certification Date: 01/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1670 E 120TH ST
LOS ANGELES CA
90059-3026
US

IV. Provider business mailing address

1670 E 120TH ST
LOS ANGELES CA
90059-3026
US

V. Phone/Fax

Practice location:
  • Phone: 424-338-1501
  • Fax: 310-632-3748
Mailing address:
  • Phone: 424-338-1501
  • Fax: 310-632-3748

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC52696
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: