Provider Demographics
NPI:1053732586
Name:ROBERTS, DORIS A (MA EDS)
Entity type:Individual
Prefix:
First Name:DORIS
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MA EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1332 LA MIRADA CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ALAMOS
Mailing Address - State:NM
Mailing Address - Zip Code:87544-2767
Mailing Address - Country:US
Mailing Address - Phone:505-501-3647
Mailing Address - Fax:505-662-7404
Practice Address - Street 1:2101 TRINITY DR STE T
Practice Address - Street 2:
Practice Address - City:LOS ALAMOS
Practice Address - State:NM
Practice Address - Zip Code:87544-4103
Practice Address - Country:US
Practice Address - Phone:505-501-3647
Practice Address - Fax:505-662-7404
Is Sole Proprietor?:No
Enumeration Date:2013-12-31
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes373H00000XNursing Service Related ProvidersDay Training/Habilitation Specialist