Provider Demographics
NPI:1518620558
Name:ROTHFARB, PAIGE JORDYN
Entity Type:Individual
Prefix:
First Name:PAIGE
Middle Name:JORDYN
Last Name:ROTHFARB
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5215 SEPULVEDA BLVD UNIT 27F
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-5255
Mailing Address - Country:US
Mailing Address - Phone:310-486-9644
Mailing Address - Fax:
Practice Address - Street 1:5215 SEPULVEDA BLVD UNIT 27F
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-5255
Practice Address - Country:US
Practice Address - Phone:310-486-9644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-17
Last Update Date:2021-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer