Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0205X | Pediatric Endocrinologist | A159825 | CA |
NPI | 1114161502 |
---|---|
Provider Name | Mary Scott Roberts |
First Address | Novato, CA 94949-5746 |
Second Address | Washington, DC 20010-2916 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/04/2009 |
Last Update Date | 08/02/2021 |