Provider Demographics
NPI:1952464216
Name:ROOTLIEB, REBECCA T (MD)
Entity Type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:T
Last Name:ROOTLIEB
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 1:1100 S COAST HWY STE 214
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-2975
Mailing Address - Country:US
Mailing Address - Phone:949-371-3336
Mailing Address - Fax:949-289-9170
Practice Address - Street 1:1100 S COAST HWY STE 214
Practice Address - Street 2:
Practice Address - City:LAGUNA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92651-2975
Practice Address - Country:US
Practice Address - Phone:949-371-3336
Practice Address - Fax:949-289-9170
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77721207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine