Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207YS0123X | Facial Plastic Surgeon | OT013763 | PA |
Y | 207YX0905X | Otolaryngology/Facial Plastic Surgery | 20A13954 | CA |
NPI | 1962722108 |
---|---|
Provider Name | Dr. Todd M. Roberts |
First Address | Murrieta, CA 92562-5987 |
Second Address | Murrieta, CA 92562-5987 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/06/2010 |
Last Update Date | 18/01/2016 |