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NPI Code Detail

MEDICARE: MARY ROBERTSON

MEDICARE: MARY ROBERTSON
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1780540583
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARY ROBERTSON
Provider Business Mailing Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 209-687-7859
Fax Number :
Provider Business Practice Location Address
First Line : 41550 ECLECTIC ST
Second Line :
City : PALM DESERT
State : CA
Zip : 92260-1967
Country : US
Telephone Number : 209-687-7859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/25/2025
Last Update Date : 12/25/2025

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Directions to “ MARY ROBERTSON ” Practice Location

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