Provider Demographics
NPI:1912042896
Name:ROTH, TRISHA ROTHENBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:TRISHA
Middle Name:ROTHENBERG
Last Name:ROTH
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 1:10309 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5007
Mailing Address - Country:US
Mailing Address - Phone:310-201-0355
Mailing Address - Fax:310-201-0246
Practice Address - Street 1:10309 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 350
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5007
Practice Address - Country:US
Practice Address - Phone:310-201-0355
Practice Address - Fax:310-201-0246
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22623208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics