Provider Demographics
NPI:1275790040
Name:PERITO, EMILY ROTHBAUM (MD)
Entity Type:Individual
Prefix:DR
First Name:EMILY
Middle Name:ROTHBAUM
Last Name:PERITO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:EMILY
Other - Middle Name:JANE
Other - Last Name:ROTHBAUM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:500 PARNASSUS AVE
Mailing Address - Street 2:MU408E BOX 0136
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143
Mailing Address - Country:US
Mailing Address - Phone:415-476-5892
Mailing Address - Fax:415-476-1343
Practice Address - Street 1:500 PARNASSUS AVE UNIVERSITY OF CALIFORNIA SAN FRANCISC
Practice Address - Street 2:MU408E, BOX 0136 PEDIATRIC GASTROENTEROLOGY
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143
Practice Address - Country:US
Practice Address - Phone:415-476-5892
Practice Address - Fax:415-476-1343
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-20
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY245251-1208000000X
CAA1089982080P0206X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics