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General NPI Number Information
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NPI Number | 1346772142
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Entity Type | Individual
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Provider Name | EDWARD SAMUEL ROTHENBERG MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2017
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Last Update Date | 05/03/2024
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Provider Practice Location Address
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Address Line | 150 W WASHINGTON ST FL 3
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City | SAN DIEGO
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State | CA
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Zip | 92103-2005
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Country | US
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Telephone | 858-658-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 1801 W OLYMPIC BLVD # 1315
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City | PASADENA
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State | CA
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Zip | 91199-0001
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | A162141
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License Number State | CA
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