Doctor Name: | EMMANUEL MARIANO ROBERTS |
NPI Number: | 1154678100 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MA |
License Number: | |
Business Practice Address: | 474 W Vermont Ave Ste. 101 Escondido, CA - 920256584 |
Business Phone Number: | 7604802255 |
Business Fax Number: | 7607416645 |
Mailing Address: | 474 W Vermont Ave, Ste. 101 ESCONDIDO |
State: | CA |
Postal Code: | 920256584 |
Phone Number: | 7604802255 |
Fax Number: | 7607416645 |
NPI Enumeration Date: | 08/09/2012 |
NPI Last Update Date: | 09/19/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |