Provider Demographics
NPI:1720091572
Name:ROTH, JULIE ANNE (DO)
Entity type:Individual
Prefix:DR
First Name:JULIE
Middle Name:ANNE
Last Name:ROTH
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:769 MEDICAL CENTER CT STE 303
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-6602
Mailing Address - Country:US
Mailing Address - Phone:619-591-9001
Mailing Address - Fax:619-591-9211
Practice Address - Street 1:769 MEDICAL CENTER CT STE 303
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-6602
Practice Address - Country:US
Practice Address - Phone:619-591-9001
Practice Address - Fax:619-591-9211
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2025-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7989207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00AX79890Medicaid
CAH72231Medicare UPIN
CA00AX79890Medicaid