Healthcare Provider Details

I. General information

NPI: 1083772479
Provider Name (Legal Business Name): STEVEN EDWARD ROBERTS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 06/21/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47647 CALEO BAY DR SUITE 200
LA QUINTA CA
92253-8854
US

IV. Provider business mailing address

47647 CALEO BAY DR SUITE 200
LA QUINTA CA
92253-8854
US

V. Phone/Fax

Practice location:
  • Phone: 760-777-8282
  • Fax:
Mailing address:
  • Phone: 760-777-8282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License NumberA76574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: