Provider Demographics
NPI:1306868252
Name:SERGIO E ROJTER MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:SERGIO E ROJTER MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SERGIO
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROJTER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-250-3344
Mailing Address - Street 1:1245 WILSHIRE BLVD STE 770
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-4881
Mailing Address - Country:US
Mailing Address - Phone:213-250-3344
Mailing Address - Fax:213-977-4993
Practice Address - Street 1:1245 WILSHIRE BLVD STE 770
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-4881
Practice Address - Country:US
Practice Address - Phone:213-250-3344
Practice Address - Fax:213-977-4993
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2023-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63254207RI0008X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A632540Medicaid
CAH68632Medicare UPIN
CAW16863Medicare ID - Type Unspecified