Healthcare Provider Details

I. General information

NPI: 1417686379
Provider Name (Legal Business Name): KARA ROBERTS LAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2022
Last Update Date: 06/07/2022
Certification Date: 06/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21321 E OCOTILLO RD STE 132
QUEEN CREEK AZ
85142-5995
US

IV. Provider business mailing address

4465 S WAYNE PL
CHANDLER AZ
85249-3102
US

V. Phone/Fax

Practice location:
  • Phone: 602-759-0512
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLAC-20236
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: