Healthcare Provider Details

I. General information

NPI: 1043678188
Provider Name (Legal Business Name): MATTHEW ROBERTS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2016
Last Update Date: 02/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1755 GRASS VALLEY HWY
AUBURN CA
95603-2854
US

IV. Provider business mailing address

1755 GRASS VALLEY HWY
AUBURN CA
95603-2854
US

V. Phone/Fax

Practice location:
  • Phone: 530-823-3143
  • Fax:
Mailing address:
  • Phone: 530-823-3143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: