Provider Demographics
NPI:1093161903
Name:ROBERG, DYLAN (DPM)
Entity Type:Individual
Prefix:
First Name:DYLAN
Middle Name:
Last Name:ROBERG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3160 TELEGRAPH RD
Mailing Address - Street 2:STE 207
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3256
Mailing Address - Country:US
Mailing Address - Phone:805-485-6708
Mailing Address - Fax:
Practice Address - Street 1:451 W GONZALES RD STE 260
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93036-0729
Practice Address - Country:US
Practice Address - Phone:805-485-6708
Practice Address - Fax:805-278-2299
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-10
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE5624213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery