Healthcare Provider Details

I. General information

NPI: 1679150932
Provider Name (Legal Business Name): ELIZABETH ANNE ROBERTSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 06/14/2024
Certification Date: 06/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1840 SIERRA GARDENS DR
ROSEVILLE CA
95661-2912
US

IV. Provider business mailing address

1840 SIERRA GARDENS DR
ROSEVILLE CA
95661-2912
US

V. Phone/Fax

Practice location:
  • Phone: 916-784-4050
  • Fax:
Mailing address:
  • Phone: 916-784-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA186846
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: