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NPI Code Detail

MEDICARE: ROBERSONLTD

MEDICARE: ROBERSONLTD
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
1251S00000XCommunity/Behavioral Health Agency
2363A00000XPhysician Assistant546NV
3363AM0700XMedical Physician Assistant546NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235309030
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERSONLTD
Provider Business Mailing Address
First Line : 3211 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1953
Country : US
Telephone Number : 702-871-3730
Fax Number : 702-871-7379
Provider Business Practice Location Address
First Line : 3211 W CHARLESTON BLVD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89102-1953
Country : US
Telephone Number : 702-871-3730
Fax Number : 702-871-7379
Authorized Official
Title or Position : PHYSICIAN ASSISTANT
Name : MS. CHARLEZETTA ROBERSON
Credential : PA
Telephone Number : 702-871-3730
Provider Enumeration Date : 03/07/2008
Last Update Date : 04/05/2019

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Directions to “ROBERSONLTD ” Practice Location

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