Provider Demographics
NPI:1053590422
Name:ROTMAN MEDICAL CORPORATION
Entity type:Organization
Organization Name:ROTMAN MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ARON
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-347-1233
Mailing Address - Street 1:PO BOX 13910
Mailing Address - Street 2:
Mailing Address - City:PALM DESERT
Mailing Address - State:CA
Mailing Address - Zip Code:92255-3910
Mailing Address - Country:US
Mailing Address - Phone:760-347-1233
Mailing Address - Fax:
Practice Address - Street 1:81880 DR CARREON BLVD
Practice Address - Street 2:SUITE C104
Practice Address - City:INDIO
Practice Address - State:CA
Practice Address - Zip Code:92201-5559
Practice Address - Country:US
Practice Address - Phone:760-347-1233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2007-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG73976305R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22069ZMedicare PIN
CAF39752Medicare UPIN