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General NPI Number Information
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NPI Number | 1154950616
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Entity Type | Individual
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Provider Name | MICHELLE ROBERTS PA-C
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Gender | Female
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Dates
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Enumeration Date | 04/06/2020
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Last Update Date | 04/06/2020
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Provider Practice Location Address
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Address Line | 2317 VIA CASCABEL
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City | ESCONDIDO
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State | CA
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Zip | 92027-4821
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Country | US
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Telephone | 760-807-2680
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1340
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City | ESCONDIDO
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State | CA
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Zip | 92033-1340
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 57933
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License Number State | CA
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