Healthcare Provider Details

I. General information

NPI: 1255895686
Provider Name (Legal Business Name): MARLENE E ROBERTS PHD, FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2019
Last Update Date: 07/21/2022
Certification Date: 07/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2027 VILLAGE LN STE 102
SOLVANG CA
93463-2271
US

IV. Provider business mailing address

200 41ST ST
MANHATTAN BEACH CA
90266-3141
US

V. Phone/Fax

Practice location:
  • Phone: 805-681-7700
  • Fax:
Mailing address:
  • Phone: 805-453-2444
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberF09181574
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberF09181574
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: