Healthcare Provider Details

I. General information

NPI: 1447382163
Provider Name (Legal Business Name): JANELL ALINE ROUTH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2007
Last Update Date: 06/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

2663 KNOX ST NE
ATLANTA GA
30317-2831
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-2000
  • Fax:
Mailing address:
  • Phone: 303-808-2766
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA95788
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: