Provider Demographics
NPI:1760884563
Name:ROTH, ALEXA ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:ALEXA
Middle Name:ELIZABETH
Last Name:ROTH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:205 E RIVER PARK CIR
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-1571
Mailing Address - Country:US
Mailing Address - Phone:559-261-4500
Mailing Address - Fax:
Practice Address - Street 1:1000 W CARSON ST
Practice Address - Street 2:HARBOR-UCLA MEDICAL CENTER, BOX 461
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2004
Practice Address - Country:US
Practice Address - Phone:310-222-2700
Practice Address - Fax:310-533-1841
Is Sole Proprietor?:No
Enumeration Date:2014-09-23
Last Update Date:2020-04-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA165647208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery