Healthcare Provider Details

I. General information

NPI: 1508828831
Provider Name (Legal Business Name): DWIGHT L. ROBERSON, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16444 PARAMOUNT BLVD SUITE #208
PARAMOUNT CA
90723-5422
US

IV. Provider business mailing address

16444 PARAMOUNT BLVD SUITE #208
PARAMOUNT CA
90723-5422
US

V. Phone/Fax

Practice location:
  • Phone: 562-790-8545
  • Fax: 562-790-2433
Mailing address:
  • Phone: 562-790-8545
  • Fax: 562-790-2433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208200000X
TaxonomyPlastic Surgery Physician
License NumberG32654
License Number StateCA

VIII. Authorized Official

Name: MRS. ESTHER LOUISE ROBERSON
Title or Position: OFFICE MANAGER
Credential:
Phone: 562-790-8545