MEDICARE: JOSHUA MICHAEL ROBERS NP

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
1	363LA2200X	Adult Health Nurse Practitioner	21240	CA
2	363LA2200X	Adult Health Nurse Practitioner	209010384	IL

General Provider Information

NPI Number	:	1487902565
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOSHUA MICHAEL ROBERS NP

Provider Business Mailing Address
First Line	:	1809 S POINT VIEW ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4623
Country	:	US
Telephone Number	:	646-234-8696
Fax Number	:

Provider Business Practice Location Address
First Line	:	1809 S POINT VIEW ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4623
Country	:	US
Telephone Number	:	646-234-8696
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/21/2012
Last Update Date	:	03/11/2016

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