Healthcare Provider Details

I. General information

NPI: 1043308687
Provider Name (Legal Business Name): LINDA ANN ROBERTS REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

IV. Provider business mailing address

5321 VIA MARISOL
LOS ANGELES CA
90042-4883
US

V. Phone/Fax

Practice location:
  • Phone: 323-478-8200
  • Fax: 323-344-8829
Mailing address:
  • Phone: 323-478-8200
  • Fax: 323-344-8829

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number416969
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: