Provider Demographics
NPI:1114248242
Name:ROBERTS, JOAN BIANCA (MD)
Entity Type:Individual
Prefix:
First Name:JOAN
Middle Name:BIANCA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:PHYSICIAN SUPPORT SERVICES
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:916-379-2948
Mailing Address - Fax:916-858-7065
Practice Address - Street 1:4400 DUCKHORN DR
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-2589
Practice Address - Country:US
Practice Address - Phone:916-575-8000
Practice Address - Fax:916-575-8099
Is Sole Proprietor?:No
Enumeration Date:2010-06-11
Last Update Date:2013-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA117574207Q00000X, 208D00000X
CAA117547207QA0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No207QA0000XAllopathic & Osteopathic PhysiciansFamily MedicineAdolescent Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice