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General NPI Number Information
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NPI Number | 1023287695
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Entity Type | Organization
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Legal Business Name | ROBERT ROTH MD A PROFESSIONAL
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Dates
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Enumeration Date | 02/27/2008
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Last Update Date | 08/31/2021
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Provider Practice Location Address
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Address Line | 2647 BOX CANYON DR
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City | LAS VEGAS
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State | NV
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Zip | 89128-0450
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Country | US
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Telephone | 702-363-5575
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Fax | 702-646-1727
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Provider Business Mailing Address
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Address Line | 2647 BOX CANYON DR
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City | LAS VEGAS
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State | NV
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Zip | 89128-0450
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Country | US
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Telephone | 702-363-5575
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Fax | 702-646-1727
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Authorized Official
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Title or Position | BILLER/CODER
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Name | ASHLEY NUSS
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Credential | CPC
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Telephone | 702-363-5575
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 8797
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License Number State | NV
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