Healthcare Provider Details

I. General information

NPI: 1811082456
Provider Name (Legal Business Name): DONALD BRIAN ROBERTS M.S.,ATC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13691 BENSON AVE
CHINO CA
91710
US

IV. Provider business mailing address

1706 AUTUMNGLOW DR
DIAMOND BAR CA
91765
US

V. Phone/Fax

Practice location:
  • Phone: 909-628-4141
  • Fax: 909-628-4242
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number785-637
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: