Provider Demographics
NPI:1053990036
Name:ROBERTS, EMMA
Entity type:Individual
Prefix:
First Name:EMMA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7433
Mailing Address - Country:US
Mailing Address - Phone:858-249-1206
Mailing Address - Fax:858-657-7212
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7433
Practice Address - Country:US
Practice Address - Phone:858-249-1206
Practice Address - Fax:858-657-7212
Is Sole Proprietor?:No
Enumeration Date:2021-04-06
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program