Organization
SAINT JOHN'S TOWER IMAGING MEDICAL GROUP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
GERALD M ROTH M.D. (PRESIDENT)
(323) 549-3030
Entity
Organization
Contact information
Practice address
1328 22ND ST, DEPARTMENT OF RADIOLOGY, SANTA MONICA, CA 90404-2032
(310) 829-8814
(310) 315-6192
Mailing address
DEPT LA 21568, PASADENA, CA 91185-1568
(888) 727-1073
(866) 752-2240
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0059370
—
CA
01
—
ZZZ39865Z
BLUE SHIELD OF CA
CA
Enumeration date
05/24/2006
Last updated
04/02/2009
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