MEDICARE: DORINDA MARY ROBERTS 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	363L00000X	Nurse Practitioner	606305	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	GR0095860	OTHER	CA	MEDI-CAL GROUP NUMBER
2	GR0095862	OTHER	CA	HP MEDICAL NUMBER

General Provider Information

NPI Number	:	1801937438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DORINDA MARY ROBERTS NP

Provider Business Mailing Address
First Line	:	2700 S FIGUEROA ST
Second Line	:	A
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3255
Country	:	US
Telephone Number	:	213-743-9050
Fax Number	:	213-747-7768

Provider Business Practice Location Address
First Line	:	2700 S FIGUEROA ST
Second Line	:	A
City	:	LOS ANGELES
State	:	CA
Zip	:	90007-3255
Country	:	US
Telephone Number	:	213-743-9050
Fax Number	:	213-747-7768

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

Provider Enumeration Date	:	02/08/2007
Last Update Date	:	07/08/2007

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