G & J Roth Professional Corp

Primary specialty

Non-Pharmacy Dispensing SiteTaxonomy code 332900000X

License

20A5200 Issued in CA

Legal business name

G & J ROTH PROFESSIONAL CORP

Doing business as

Timothy J. Roth, DO

Practice address

255 W Bullard Ave
102
Clovis, CA 93612-0861

Phone

(559) 299-2128

NPI assigned

Feb 13, 2007

Last updated

Oct 17, 2012By the provider in NPPES

Organization subpart

Yes

Parent organization

MEDVANTX, INC.As reported in NPPES

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kenny Heine

Title

Director of Operations

Phone

(858) 625-2990

Specialties & licenses 1

Addresses

Other names 1

• Timothy J. Roth, DO Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Part of

Medvantx Inc

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1171324800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1350432000000",
    "number": "1275675480",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5626 OBERLIN DR",
            "address_2": "SUITE 110",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921211705"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "255 W BULLARD AVE",
            "address_2": "102",
            "city": "CLOVIS",
            "state": "CA",
            "postal_code": "936120861",
            "telephone_number": "559-299-2128"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "G & J ROTH PROFESSIONAL CORP",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MEDVANTX, INC.",
        "enumeration_date": "2007-02-13",
        "last_updated": "2012-10-17",
        "status": "A",
        "authorized_official_last_name": "HEINE",
        "authorized_official_first_name": "KENNY",
        "authorized_official_title_or_position": "DIRECTOR OF OPERATIONS",
        "authorized_official_telephone_number": "858-625-2990"
    },
    "taxonomies": [
        {
            "code": "332900000X",
            "taxonomy_group": "",
            "desc": "Non-Pharmacy Dispensing Site",
            "state": "CA",
            "license": "20A5200",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Timothy J. Roth, DO",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Non-Pharmacy Dispensing Site in Clovis, CA
• Providers in Clovis, CA by specialty
• Non-Pharmacy Dispensing Site in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 17, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.