Healthcare Provider Details

I. General information

NPI: 1609971027
Provider Name (Legal Business Name): ROBERT HOWARD ROTH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/13/2006
Last Update Date: 09/05/2023
Certification Date:
Deactivation Date: 08/02/2023
Reactivation Date: 09/05/2023

III. Provider practice location address

25775 MCBEAN PKWY
VALENCIA CA
91355-3708
US

IV. Provider business mailing address

PO BOX 9602
MISSION HILLS CA
91346-9602
US

V. Phone/Fax

Practice location:
  • Phone: 661-424-8830
  • Fax: 661-424-8831
Mailing address:
  • Phone: 818-837-5637
  • Fax: 818-837-5589

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberG32092
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: