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General NPI Number Information
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NPI Number | 1508057316
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Entity Type | Individual
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Provider Name | KAY DEE ROBERTS PA
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Gender | Male
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Dates
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Enumeration Date | 08/06/2007
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Last Update Date | 07/07/2016
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Provider Practice Location Address
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Address Line | 41230 11TH ST W STE E
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City | PALMDALE
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State | CA
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Zip | 93551-1411
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Country | US
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Telephone | 661-273-1614
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Fax | 661-273-4816
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Provider Business Mailing Address
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Address Line | 38460 5TH ST W
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City | PALMDALE
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State | CA
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Zip | 93551-4685
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Country | US
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Telephone | 661-273-1614
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Fax | 661-273-4816
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA011543
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License Number State | CA
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