Individual
GERALD M ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2202 WILSHIRE BLVD, SANTA MONICA, CA 90403-5706
(310) 264-9000
(310) 264-9004
Mailing address
DEPT LA 21559, PASADENA, CA 91185-1559
(949) 263-8620
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G76013
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G670130
—
CA
01
—
00G760130
BLUE SHIELD OF CA
CA
Enumeration date
06/01/2006
Last updated
11/30/2007
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