Healthcare Provider Details

I. General information

NPI: 1043150469
Provider Name (Legal Business Name): LEVI ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2026
Last Update Date: 03/30/2026
Certification Date: 03/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 GREENLEY RD
SONORA CA
95370-5200
US

IV. Provider business mailing address

425 WILLIAMS ST
MURPHYS CA
95247-9697
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-5000
  • Fax:
Mailing address:
  • Phone: 925-813-2424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95029470
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: