Individual
LORI ROTH POCETA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
12395 EL CAMINO REAL, SAN DIEGO, CA 92130-3082
(858) 794-1250
Mailing address
FILE # 54433, LOS ANGELES, CA 90074-0001
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
16520
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
16520
MEDICAL LICENSE
CA
01
—
330654354
TAX ID
CA
Enumeration date
12/05/2006
Last updated
07/10/2009
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