Healthcare Provider Details

I. General information

NPI: 1689785123
Provider Name (Legal Business Name): CRAIG ROTHBACH M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/10/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

227 N JACKSON AVE
SAN JOSE CA
95116-1603
US

IV. Provider business mailing address

400 RACE ST
SAN JOSE CA
95126-3518
US

V. Phone/Fax

Practice location:
  • Phone: 408-347-2030
  • Fax: 408-347-2192
Mailing address:
  • Phone: 408-278-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA26139
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: