Organization
G & J ROTH PROFESSIONAL CORP
Active
Parent organization
MEDVANTX, INC.
Other names
Timothy J. Roth, DO
Organization subpart
Yes
Provider details
NPI number
Legal business name
MEDVANTX, INC.
Authorized official
KENNY HEINE (DIRECTOR OF OPERATIONS)
(858) 625-2990
Entity
Organization
Contact information
Practice address
255 W BULLARD AVE, 102, CLOVIS, CA 93612-0861
(559) 299-2128
Mailing address
5626 OBERLIN DR, SUITE 110, SAN DIEGO, CA 92121-1705
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
20A5200
CA
Other
Enumeration date
02/13/2007
Last updated
10/17/2012
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