Healthcare Provider Details

I. General information

NPI: 1366461220
Provider Name (Legal Business Name): JAY STEVEN ROITMAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1093 HILLTOP DR
REDDING CA
96003-3811
US

IV. Provider business mailing address

2530 RUBY CT
REDDING CA
96001-3733
US

V. Phone/Fax

Practice location:
  • Phone: 530-221-1565
  • Fax: 530-221-3912
Mailing address:
  • Phone: 530-221-1565
  • Fax: 530-221-3912

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A5805
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: