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General NPI Number Information
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NPI Number | 1699709048
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Entity Type | Individual
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Provider Name | BRADLEY J ROTH MD
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Gender | Male
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 07/21/2015
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Provider Practice Location Address
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Address Line | 11550 INDIAN HILLS ROAD, SUITE 310
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City | MISSION HILLS
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State | CA
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Zip | 91345-1203
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Country | US
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Telephone | 818-898-4900
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Fax | 818-898-4990
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Provider Business Mailing Address
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Address Line | 25050 AVENUE KEARNY SUITE 208
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City | VALENCIA
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State | CA
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Zip | 91355-1257
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Country | US
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Telephone | 661-430-0940
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Fax | 661-295-0862
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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 | 2086S0127X
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Taxonomy Name | Trauma Surgery Physician
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License Number | G84133
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License Number State | CA
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