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General NPI Number Information
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NPI Number | 1548751969
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Entity Type | Individual
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Provider Name | EVELYN ROTH
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Gender | Female
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Dates
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Enumeration Date | 05/21/2018
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Last Update Date | 08/22/2024
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Provider Practice Location Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone | 866-542-2865
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Fax | 224-538-3267
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Provider Business Mailing Address
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Address Line | 15785 LAGUNA CANYON RD STE 125
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City | IRVINE
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State | CA
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Zip | 92618-3140
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Country | US
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Telephone | 866-542-2865
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Fax | 224-538-3267
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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 | 363LX0001X
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Taxonomy Name | Obstetrics & Gynecology Nurse Practitioner
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License Number | 814703
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | NP95008456
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License Number State | CA
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