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NPI Code Detail

MEDICARE: ANDREA MARIE ROBERTSON RADT1

MEDICARE: ANDREA MARIE ROBERTSON RADT1
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
1101Y00000XCounselorR1213950915CA

General Provider Information

NPI Number : 1215307038
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANDREA MARIE ROBERTSON RADT1
Provider Business Mailing Address
First Line : 1149 WARREN AVE
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7512
Country : US
Telephone Number : 707-552-5295
Fax Number : 707-553-3394
Provider Business Practice Location Address
First Line : 1149 WARREN AVE
Second Line :
City : VALLEJO
State : CA
Zip : 94591-7512
Country : US
Telephone Number : 707-552-5295
Fax Number : 707-553-3394
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/06/2015
Last Update Date : 10/06/2015

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Directions to “ ANDREA MARIE ROBERTSON RADT1” Practice Location

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