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NPI Code Detail

MEDICARE: MRS. JILLIAN ROTHGEB OFT MD

MEDICARE:  MRS. JILLIAN ROTHGEB OFT  MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program
2207RI0200XInfectious Disease PhysicianA119483CA

General Provider Information

NPI Number : 1184940876
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JILLIAN ROTHGEB OFT MD
Provider Business Mailing Address
First Line : PO BOX 54679
Second Line :
City : LOS ANGELES
State : CA
Zip : 90054-0679
Country : US
Telephone Number : 310-358-2300
Fax Number : 310-358-2308
Provider Business Practice Location Address
First Line : 8635 W 3RD ST STE 465W
Second Line :
City : LOS ANGELES
State : CA
Zip : 90048-6111
Country : US
Telephone Number : 310-358-2300
Fax Number : 310-358-2308
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/20/2010
Last Update Date : 05/21/2019

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