Healthcare Provider Details

I. General information

NPI: 1649516618
Provider Name (Legal Business Name): DAWN TANYA ROBERTS D.C.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2012
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2605 ALPINE BLVD STE. 2
ALPINE CA
91901-6206
US

IV. Provider business mailing address

2605 ALPINE BLVD STE. 2
ALPINE CA
91901-6206
US

V. Phone/Fax

Practice location:
  • Phone: 619-659-8352
  • Fax: 619-445-2106
Mailing address:
  • Phone: 619-659-8352
  • Fax: 619-445-2106

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC27934
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: