Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 33249 | CA |
NPI | 1417334210 |
---|---|
Provider Name | Mr. Jeremy Andrew Roberts |
First Address | Long Beach, CA 90804-4085 |
Second Address | Long Beach, CA 90804-4085 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/04/2015 |
Last Update Date | 30/04/2015 |