Healthcare Provider Details

I. General information

NPI: 1629143813
Provider Name (Legal Business Name): STEPHANIE ROBERTS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/22/2006
Last Update Date: 04/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10390 COLOMA RD #B
RANCHO CORDOVA CA
95670-2152
US

IV. Provider business mailing address

10390 COLOMA RD #B
RANCHO CORDOVA CA
95670-2152
US

V. Phone/Fax

Practice location:
  • Phone: 916-363-2229
  • Fax:
Mailing address:
  • Phone: 916-363-2229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RB0002X
TaxonomyObesity Medicine (Internal Medicine) Physician
License NumberG82261
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: