Healthcare Provider Details

I. General information

NPI: 1164384541
Provider Name (Legal Business Name): AMY ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/24/2025
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5151 SHOREHAM PL STE 175
SAN DIEGO CA
92122-5925
US

IV. Provider business mailing address

6135 LAKEWOOD ST
SAN DIEGO CA
92122-3901
US

V. Phone/Fax

Practice location:
  • Phone: 805-915-9994
  • Fax:
Mailing address:
  • Phone: 805-915-9994
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number20258
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: