Healthcare Provider Details

I. General information

NPI: 1811924434
Provider Name (Legal Business Name): MISHA G ROITSHTEYN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 FIRST ST STE 100
PLEASANTON CA
94566
US

IV. Provider business mailing address

27212 CALAROGA AVE
HAYWARD CA
94545-4339
US

V. Phone/Fax

Practice location:
  • Phone: 925-462-7060
  • Fax: 925-462-9712
Mailing address:
  • Phone: 510-785-5000
  • Fax: 510-784-2502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51685
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: