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General NPI Number Information
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NPI Number | 1922050525
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Entity Type | Individual
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Provider Name | RAUL FERNANDO ROTH M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/16/2006
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Last Update Date | 08/01/2024
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Provider Practice Location Address
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Address Line | 625 S FAIR OAKS AVE STE 215
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City | PASADENA
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State | CA
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Zip | 91105-2613
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Country | US
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Telephone | 626-793-4139
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Fax | 626-793-4324
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Provider Business Mailing Address
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Address Line | PO BOX 80011
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City | CITY OF INDUSTRY
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State | CA
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Zip | 91716-8011
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Country | US
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Telephone | 626-793-2885
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Fax | 626-793-6262
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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 | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | G56414
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License Number State | CA
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