Individual
BRADLEY J ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11550 INDIAN HILLS ROAD,, SUITE 310, MISSION HILLS, CA 91345-1203
(818) 898-4900
(818) 898-4990
Mailing address
25050 AVENUE KEARNY, SUITE 208, VALENCIA, CA 91355-1257
(661) 430-0940
(661) 295-0862
Taxonomy
Speciality
Code
Description
License number
State
2086S0127X
Trauma Surgery Physician
Primary
G84133
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00G841330
INDIVIDUAL BLUE SHIELD
CA
05
—
00G841330
—
CA
01
—
00G841330C29
CAL OPTIMA
CA
01
—
020048518
MEDICARE RAILROAD
CA
Enumeration date
07/10/2006
Last updated
07/21/2015
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