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General NPI Number Information
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NPI Number | 1497574628
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Entity Type | Individual
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Provider Name | CARRIE E ROBERTSS
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Gender | Female
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Dates
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Enumeration Date | 10/04/2024
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 1320 W 131ST ST
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City | COMPTON
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State | CA
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Zip | 90222-1940
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Country | US
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Telephone | 424-785-7247
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Fax |
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Provider Business Mailing Address
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Address Line | 1115 N WILMINGTON AVE # 1-144
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City | COMPTON
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State | CA
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Zip | 90222-3861
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Country | US
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Telephone | 424-346-4267
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number | 0003336745-0001-6
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License Number State | CA
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