MEDICARE: DYLAN ROBERG D.P.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	E5624	CA

General Provider Information

NPI Number	:	1093161903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DYLAN ROBERG D.P.M

Provider Business Mailing Address
First Line	:	3160 TELEGRAPH RD
Second Line	:	STE 207
City	:	VENTURA
State	:	CA
Zip	:	93003-3256
Country	:	US
Telephone Number	:	805-485-6708
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 W GONZALES RD STE 260
Second Line	:
City	:	OXNARD
State	:	CA
Zip	:	93036-0729
Country	:	US
Telephone Number	:	805-485-6708
Fax Number	:	805-278-2299

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/10/2016
Last Update Date	:	07/17/2023

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