Provider Demographics
NPI:1316944200
Name:ROTHBART, JASON A (MD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:A
Last Name:ROTHBART
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10309 SANTA MONICA BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5007
Mailing Address - Country:US
Mailing Address - Phone:310-552-3232
Mailing Address - Fax:310-282-8567
Practice Address - Street 1:10309 SANTA MONICA BLVD
Practice Address - Street 2:STE 300
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5007
Practice Address - Country:US
Practice Address - Phone:310-552-3232
Practice Address - Fax:310-282-8567
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-07
Last Update Date:2012-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83202207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology