MEDICARE: MR. ALEXANDER EMANUEL ROTHIS 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
1	207L00000X	Anesthesiology Physician	G81849	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00G818490	OTHER	CA	BLUE SHIELD

General Provider Information

NPI Number	:	1548473283
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ALEXANDER EMANUEL ROTHIS MD

Provider Business Mailing Address
First Line	:	2238 JEFFERSONIA WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1818
Country	:	US
Telephone Number	:	310-440-9160
Fax Number	:	310-440-9160

Provider Business Practice Location Address
First Line	:	2238 JEFFERSONIA WAY
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-1818
Country	:	US
Telephone Number	:	310-440-9160
Fax Number	:	310-440-9160

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/08/2007
Last Update Date	:	07/29/2011

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