Healthcare Provider Details

I. General information

NPI: 1023178035
Provider Name (Legal Business Name): TARA RENE ROBERTS MS, CCC-A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 01/27/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2025 MORSE AVE HEAD AND NECK SURGERY DEPARTMENT - 3E
SACRAMENTO CA
95825-2115
US

IV. Provider business mailing address

2025 MORSE AVE HEAD AND NECK SURGERY DEPARTMENT - 3E
SACRAMENTO CA
95825-2115
US

V. Phone/Fax

Practice location:
  • Phone: 916-973-7913
  • Fax: 916-973-7971
Mailing address:
  • Phone: 916-973-7913
  • Fax: 916-973-7971

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberAU1936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: