Provider Demographics
NPI:1104609429
Name:ROTHE, ELLA AUTUMN
Entity type:Individual
Prefix:
First Name:ELLA
Middle Name:AUTUMN
Last Name:ROTHE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9247 WHITING WAY
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92508-6255
Mailing Address - Country:US
Mailing Address - Phone:951-318-9511
Mailing Address - Fax:
Practice Address - Street 1:701 W KIMBERLY AVE STE 125
Practice Address - Street 2:
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-6346
Practice Address - Country:US
Practice Address - Phone:714-224-1409
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-18
Last Update Date:2023-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst