Provider Demographics
NPI:1265483085
Name:ROBERTSON, CYNTHIA ANN (MD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:ANN
Last Name:ROBERTSON
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 1:12630 MONTE VISTA RD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:POWAY
Mailing Address - State:CA
Mailing Address - Zip Code:92064-2530
Mailing Address - Country:US
Mailing Address - Phone:858-485-7648
Mailing Address - Fax:858-485-8010
Practice Address - Street 1:12630 MONTE VISTA RD
Practice Address - Street 2:SUITE 209
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2530
Practice Address - Country:US
Practice Address - Phone:858-485-7648
Practice Address - Fax:858-485-8010
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57999207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG84292Medicare UPIN
CAG84292Medicare ID - Type Unspecified