MEDICARE: HEATHER J ROBERTS MD

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	207N00000X	Dermatology Physician	G71960	CA

General Provider Information

NPI Number	:	1629171624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER J ROBERTS MD

Provider Business Mailing Address
First Line	:	11600 WILSHIRE BLVD
Second Line	:	#408
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1733
Country	:	US
Telephone Number	:	310-477-4727
Fax Number	:	310-477-2001

Provider Business Practice Location Address
First Line	:	11600 WILSHIRE BLVD
Second Line	:	#408
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1733
Country	:	US
Telephone Number	:	310-477-4727
Fax Number	:	310-477-2001

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	01/11/2011

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