1144537390 NPI number — MRS. KIRSTEN ROBERTS DPT

Table of content: MRS. KIRSTEN ROBERTS DPT (NPI 1144537390)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144537390 NPI number — MRS. KIRSTEN ROBERTS DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
KIRSTEN
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THORNE
Provider Other First Name:
KIRSTEN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1144537390
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6699 ALVARADO RD
Provider Second Line Business Mailing Address:
2100
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92120-5238
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
619-229-3909
Provider Business Mailing Address Fax Number:
619-229-3902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4010 SORRENTO VALLEY BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92121-1432
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-793-7860
Provider Business Practice Location Address Fax Number:
858-436-1289
Provider Enumeration Date:
09/09/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  37051 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: W12026 . This is a "GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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