Healthcare Provider Details

I. General information

NPI: 1073548681
Provider Name (Legal Business Name): TOWER PULMONARY ASSOCIATES A MED GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 S GRAND AVE STE 605
LOS ANGELES CA
90015-3068
US

IV. Provider business mailing address

1400 S GRAND AVE STE 605
LOS ANGELES CA
90015-3068
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 TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29402
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG24071
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG32106
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT K. ROTHBART
Title or Position: PRESIDENT
Credential: MD
Phone: 213-742-0910