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General NPI Number Information
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NPI Number | 1346529617
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Entity Type | Organization
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Legal Business Name | KENNETH L. ROTHMAN, M.D., INC.
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Dates
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Enumeration Date | 08/04/2011
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Last Update Date | 08/04/2011
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Provider Practice Location Address
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Address Line | 20130 LAKE CHABOT RD SUITE 202
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5340
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Country | US
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Telephone | 510-582-6424
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Fax | 510-582-6462
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Provider Business Mailing Address
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Address Line | 20130 LAKE CHABOT RD SUITE 202
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City | CASTRO VALLEY
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State | CA
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Zip | 94546-5340
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Country | US
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Telephone | 510-582-6424
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Fax | 510-582-6462
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Authorized Official
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Title or Position | PRESIDENT
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Name | KENNETH L ROTHMAN
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Credential | M.D.
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Telephone | 510-582-6424
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | G27686
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License Number State | CA
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