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NPI Code Detail

MEDICARE: ATHENA RENE ROBERTSON

MEDICARE: ATHENA RENE ROBERTSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1175T00000XPeer SpecialistCA

General Provider Information

NPI Number : 1013702208
Entity Type Code : Individual
Provider Name (Legal Business Name) : ATHENA RENE ROBERTSON
Provider Business Mailing Address
First Line : 12390 GOLDEN STATE BLVD
Second Line :
City : MADERA
State : CA
Zip : 93637-9156
Country : US
Telephone Number : 559-660-4600
Fax Number :
Provider Business Practice Location Address
First Line : 12390 GOLDEN STATE BLVD
Second Line :
City : MADERA
State : CA
Zip : 93637-9156
Country : US
Telephone Number : 559-660-4600
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/10/2025
Last Update Date : 12/21/2025

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Directions to “ ATHENA RENE ROBERTSON ” Practice Location

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