Healthcare Provider Details

I. General information

NPI: 1730349754
Provider Name (Legal Business Name): ELIZABETH J ROBERTS, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/12/2008
Last Update Date: 06/12/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25460 MEDICAL CENTER DR SUITE 203
MURRIETA CA
92562-5985
US

IV. Provider business mailing address

25460 MEDICAL CENTER DR SUITE 203
MURRIETA CA
92562-5985
US

V. Phone/Fax

Practice location:
  • Phone: 951-894-6900
  • Fax:
Mailing address:
  • Phone: 951-894-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG86360
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberG86360
License Number StateCA

VIII. Authorized Official

Name: DR. ELIZABETH JOZAITIS ROBERTS
Title or Position: PRESIDENT/PSYCHIATRIST
Credential: M.D.
Phone: 951-894-6900