# JACK ROTHBERG MD A MEDICAL COPT

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1669740338
- **Authorized official:** JACK ROTHBERG PHD, MD (OWNER)
- **Authorized official phone:** (323) 857-8000

## Contact information

- **Practice address:** 6200 WILSHIRE BLVD, SUITE 1612, LOS ANGELES, CA 90048
- **Practice address phone:** (323) 857-8000
- **Practice address fax:** (323) 857-8008
- **Mailing address:** 6200 WILSHIRE BLVD, SUITE 1612, LOS ANGELES, CA 90048
- **Mailing address phone:** (323) 857-8000
- **Mailing address fax:** (323) 857-8008

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2084F0202X | Forensic Psychiatry Physician | G29894 | CA | Yes |

## Other

- **Enumeration date:** 12/08/2011
- **Last updated:** 12/08/2011