MEDICARE: ANDREA A ROBERSON D.O

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	207Q00000X	Family Medicine Physician	20A4958	CA

General Provider Information

NPI Number	:	1952338600
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDREA A ROBERSON D.O

Provider Business Mailing Address
First Line	:	105 AVENIDA DE LA ESTRELLA STE 1A
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-3985
Country	:	US
Telephone Number	:	949-586-8000
Fax Number	:	949-429-8829

Provider Business Practice Location Address
First Line	:	105 AVENIDA DE LA ESTRELLA STE 1A
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-3985
Country	:	US
Telephone Number	:	949-586-8000
Fax Number	:	949-429-8829

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	10/18/2018

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