Healthcare Provider Details

I. General information

NPI: 1386033017
Provider Name (Legal Business Name): LESTER ROBERTSON P.A.- C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2015
Last Update Date: 01/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3991 MACARTHUR BLVD SUITE 320
NEWPORT BEACH CA
92660-3009
US

IV. Provider business mailing address

3991 MACARTHUR BLVD SUITE 320
NEWPORT BEACH CA
92660-3009
US

V. Phone/Fax

Practice location:
  • Phone: 949-720-3888
  • Fax: 714-902-1101
Mailing address:
  • Phone: 949-720-3888
  • Fax: 714-902-1101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number51465
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: