Provider Demographics
NPI:1619980455
Name:ROTHSTEIN, ANDREW R (DPM)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:R
Last Name:ROTHSTEIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69730 HIGHWAY 111
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-2869
Mailing Address - Country:US
Mailing Address - Phone:760-328-4669
Mailing Address - Fax:760-328-6719
Practice Address - Street 1:69730 HIGHWAY 111
Practice Address - Street 2:SUITE 101
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-2869
Practice Address - Country:US
Practice Address - Phone:760-328-4669
Practice Address - Fax:760-328-6719
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-14
Last Update Date:2012-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE38020213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E38020Medicaid
CAU25602Medicare UPIN
CA000E38020Medicaid