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General NPI Number Information
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NPI Number | 1235593542
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Entity Type | Organization
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Legal Business Name | SHERLYN M ROBERSON
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Dates
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Enumeration Date | 04/12/2016
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Last Update Date | 04/12/2016
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Provider Practice Location Address
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Address Line | 24415 MARIGOLD AVE
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City | HARBOR CITY
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State | CA
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Zip | 90710-1827
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Country | US
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Telephone | 310-733-6048
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Fax |
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Provider Business Mailing Address
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Address Line | 24415 MARIGOLD AVE
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City | HARBOR CITY
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State | CA
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Zip | 90710-1827
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Country | US
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Telephone | 310-733-6048
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SHERLYN MEDRA ROBERSON
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Credential | CMP
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Telephone | 310-733-6048
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | 52500
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License Number State | CA
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