Healthcare Provider Details

I. General information

NPI: 1841554029
Provider Name (Legal Business Name): ROBERT K. ROTHBART, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2012
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE SUITE 605
LOS ANGELES CA
90015-3048
US

IV. Provider business mailing address

1400 S GRAND AVE SUITE 605
LOS ANGELES CA
90015-3048
US

V. Phone/Fax

Practice location:
  • Phone: 213-742-0910
  • Fax: 213-742-6631
Mailing address:
  • Phone: 213-742-0910
  • Fax: 213-742-6631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA29402
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT K. ROTHBART
Title or Position: SOLE PROPRIETOR
Credential: M.D.
Phone: 213-742-0910