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General NPI Number Information
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NPI Number | 1235458027
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Entity Type | Individual
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Provider Name | DR. JEFFREY ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 05/19/2010
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Last Update Date | 12/01/2021
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Provider Practice Location Address
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Address Line | 9961 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone | 909-427-7419
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Fax |
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Provider Business Mailing Address
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Address Line | 9961 SIERRA AVE
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City | FONTANA
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State | CA
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Zip | 92335-6720
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Country | US
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Telephone | 909-427-7419
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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 | 213ES0000X
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Taxonomy Name | Sports Medicine Podiatrist
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License Number | PL 60088829
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | PL 60088829
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | E4976
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License Number State | CA
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