Provider Demographics
NPI:1083772479
Name:ROBERTS, STEVEN EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47647 CALEO BAY DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253-8854
Mailing Address - Country:US
Mailing Address - Phone:760-777-8282
Mailing Address - Fax:
Practice Address - Street 1:47647 CALEO BAY DR
Practice Address - Street 2:SUITE 200
Practice Address - City:LA QUINTA
Practice Address - State:CA
Practice Address - Zip Code:92253-8854
Practice Address - Country:US
Practice Address - Phone:760-777-8282
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2012-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76574207RS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0010XAllopathic & Osteopathic PhysiciansInternal MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH55237Medicare UPIN
CA00A765741Medicare ID - Type Unspecified