Healthcare Provider Details

I. General information

NPI: 1396420451
Provider Name (Legal Business Name): NIKOLE ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2023
Last Update Date: 08/02/2023
Certification Date: 08/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1483 ALVA ST
CARPINTERIA CA
93013-1501
US

IV. Provider business mailing address

501 CENTER ST APT 19
EL SEGUNDO CA
90245-3277
US

V. Phone/Fax

Practice location:
  • Phone: 805-566-0299
  • Fax:
Mailing address:
  • Phone: 281-299-4509
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number691570
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: