Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 246873 | CA |
NPI | 1013019934 |
---|---|
Provider Name | Robereta Prepas |
First Address | Costa Mesa, CA 92626 |
Second Address | Fountain Valley, CA 92708-5153 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/09/2006 |
Last Update Date | 05/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
002468730 | (05) | CA |