Healthcare Provider Details

I. General information

NPI: 1639478191
Provider Name (Legal Business Name): ASHA M ROBERTSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISS ASHA PRAKASH MANSUKHANI

II. Dates (important events)

Enumeration Date: 03/23/2011
Last Update Date: 11/15/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

363 PLAYA DEL SUR APT 21
LA JOLLA CA
92037-5961
US

IV. Provider business mailing address

363 PLAYA DEL SUR APT 21
LA JOLLA CA
92037-5961
US

V. Phone/Fax

Practice location:
  • Phone: 310-720-4395
  • Fax:
Mailing address:
  • Phone: 310-720-4395
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA124302
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: