1417746876 NPI number — SUSAN ANN ROBERTS M.S., PPS, PPSP

Table of content: SUSAN ANN ROBERTS M.S., PPS, PPSP (NPI 1417746876)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417746876 NPI number — SUSAN ANN ROBERTS M.S., PPS, PPSP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTS
Provider First Name:
SUSAN
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., PPS, PPSP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MEADOWS
Provider Other First Name:
SUSAN
Provider Other Middle Name:
ANN
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:
1417746876
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/02/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
426 N BLACKSTONE ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TULARE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93274-4449
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
559-656-5482
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
426 N BLACKSTONE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULARE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93274-4449
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
559-656-5482
Provider Business Practice Location Address Fax Number:
559-687-7317
Provider Enumeration Date:
05/02/2025

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: 103TS0200X , with the licence number:  230256220 , 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)





Copyright © 2007-2025 www.npivalidator.com