Healthcare Provider Details

I. General information

NPI: 1619810959
Provider Name (Legal Business Name): JOSEPH ANTHONY LEE-ROTH LVN/LPN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/13/2026
Certification Date: 04/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7293 DUMOSA AVE STE 2
YUCCA VALLEY CA
92284-3700
US

IV. Provider business mailing address

13148 FIRST AVE
VICTORVILLE CA
92395-8719
US

V. Phone/Fax

Practice location:
  • Phone: 760-365-2233
  • Fax:
Mailing address:
  • Phone: 760-792-0837
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number706096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: