Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 20A4414 | CA |
NPI | 1093931537 |
---|---|
Provider Name | Dr. Martin Jerome Roitman |
First Address | San Diego, CA 92108-3538 |
Second Address | San Diego, CA 92108-3538 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/04/2007 |
Last Update Date | 02/02/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
20A4414 | STATE LICENSE NUMBER (01) | CA |