Healthcare Provider Details

I. General information

NPI: 1083197354
Provider Name (Legal Business Name): NATALIE ROBERTSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NATALIE MATENAER

II. Dates (important events)

Enumeration Date: 09/12/2018
Last Update Date: 11/18/2025
Certification Date: 11/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

892 AEROVISTA PL STE 120
SAN LUIS OBISPO CA
93401-8054
US

IV. Provider business mailing address

892 AEROVISTA PL STE 120
SAN LUIS OBISPO CA
93401-8054
US

V. Phone/Fax

Practice location:
  • Phone: 805-544-5567
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55886
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: