MEDICARE: DR. JULIE ANNE ROTH DO

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	207Q00000X	Family Medicine Physician	20A7989	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720091572
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JULIE ANNE ROTH DO

Provider Business Mailing Address
First Line	:	527 H ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-4301
Country	:	US
Telephone Number	:	619-709-7367
Fax Number	:	619-775-3170

Provider Business Practice Location Address
First Line	:	527 H ST
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91910-4301
Country	:	US
Telephone Number	:	619-709-7367
Fax Number	:	619-775-3170

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

Provider Enumeration Date	:	08/14/2006
Last Update Date	:	01/14/2026

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