Provider Demographics
NPI:1427040922
Name:STROTHER, GERMAINE D (MD)
Entity Type:Individual
Prefix:
First Name:GERMAINE
Middle Name:D
Last Name:STROTHER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7197 BROCKTON AVE
Mailing Address - Street 2:STE 1
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-2637
Mailing Address - Country:US
Mailing Address - Phone:951-682-4560
Mailing Address - Fax:951-682-4535
Practice Address - Street 1:7197 BROCKTON AVE
Practice Address - Street 2:STE 1
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2637
Practice Address - Country:US
Practice Address - Phone:951-682-4560
Practice Address - Fax:951-682-4535
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG42256207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G422560Medicaid
F02748Medicare UPIN
00G422560Medicare ID - Type Unspecified