Healthcare Provider Details

I. General information

NPI: 1538846670
Provider Name (Legal Business Name): ALEX ROTH DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2023
Last Update Date: 04/24/2026
Certification Date: 04/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2020 26TH AVE E
BRADENTON FL
34208-7753
US

IV. Provider business mailing address

21808 STATE ROAD 54
LUTZ FL
33549-6923
US

V. Phone/Fax

Practice location:
  • Phone: 941-782-4344
  • Fax:
Mailing address:
  • Phone: 813-922-8621
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberUO9118
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: