Provider Demographics
NPI:1902048408
Name:ROTHENBERG, JEREMY (LAC)
Entity Type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:ROTHENBERG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 SUTTER ST
Mailing Address - Street 2:STE 908
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-1107
Mailing Address - Country:US
Mailing Address - Phone:415-449-0445
Mailing Address - Fax:
Practice Address - Street 1:500 SUTTER ST
Practice Address - Street 2:STE 908
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-1107
Practice Address - Country:US
Practice Address - Phone:415-449-0445
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12906171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist