MEDICARE: DR. TUONGVI ROATH

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	183500000X	Pharmacist	67664	CA

General Provider Information

NPI Number	:	1790033918
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TUONGVI ROATH

Provider Business Mailing Address
First Line	:	8251 MIRA MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2603
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	8251 MIRA MESA BLVD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92126-2603
Country	:	US
Telephone Number	:	858-357-2002
Fax Number	:	858-877-2032

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

Provider Enumeration Date	:	08/20/2012
Last Update Date	:	11/07/2016

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Directions to “ DR. TUONGVI ROATH ” Practice Location

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