Provider Demographics
NPI:1366461220
Name:ROITMAN, JAY STEVEN (DO)
Entity type:Individual
Prefix:
First Name:JAY
Middle Name:STEVEN
Last Name:ROITMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2530 RUBY CT
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96001-3733
Mailing Address - Country:US
Mailing Address - Phone:530-221-1565
Mailing Address - Fax:530-221-3912
Practice Address - Street 1:1093 HILLTOP DR
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-3811
Practice Address - Country:US
Practice Address - Phone:530-221-1565
Practice Address - Fax:530-221-3912
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5805207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CABR2308915OtherDEA
CA020A58053Medicare ID - Type Unspecified
CABR2308915OtherDEA