Individual
ELLEN MARIE ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
C.R.N.A.
Contact information
Practice address
9961 SIERRA AVE, ANESTHESIA DEPARTMENT, FONTANA, CA 92335-6720
(909) 427-7162
Mailing address
475 E CYPRESS AVE, APT. #302, REDLANDS, CA 92373-6169
(909) 792-1918
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
436360
CA
Other
Enumeration date
11/08/2006
Last updated
07/08/2007
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