Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | E5624 | CA |
NPI | 1093161903 |
---|---|
Provider Name | Dylan Roberg |
First Address | Ventura, CA 93003-3256 |
Second Address | Oxnard, CA 93036-0729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2016 |
Last Update Date | 02/11/2020 |