Healthcare Provider Details

I. General information

NPI: 1902902836
Provider Name (Legal Business Name): ROGER SATTERTHWAITE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 S RAYMOND AVE UNIT 220
PASADENA CA
91105-3283
US

IV. Provider business mailing address

PO BOX 512185
LOS ANGELES CA
90051-0185
US

V. Phone/Fax

Practice location:
  • Phone: 626-218-9500
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-218-5310

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG75976
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: