Healthcare Provider Details

I. General information

NPI: 1700900958
Provider Name (Legal Business Name): ROBERTA DIANE PARKER CADC LL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2914 COLD SPRINGS RD STE A
PLACERVILLE CA
95667-4220
US

IV. Provider business mailing address

7017 SERVICE CT APT B
DIAMOND SPRINGS CA
95619-9277
US

V. Phone/Fax

Practice location:
  • Phone: 530-642-1715
  • Fax:
Mailing address:
  • Phone: 530-295-1249
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA8449706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: