Provider Demographics
NPI:1275595563
Name:ROBERTSON, ARLEADA F (PA)
Entity Type:Individual
Prefix:
First Name:ARLEADA
Middle Name:F
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 FIRST ST
Mailing Address - Street 2:
Mailing Address - City:PASO ROBLES
Mailing Address - State:CA
Mailing Address - Zip Code:93446-3742
Mailing Address - Country:US
Mailing Address - Phone:805-226-4222
Mailing Address - Fax:
Practice Address - Street 1:500 FIRST ST
Practice Address - Street 2:
Practice Address - City:PASO ROBLES
Practice Address - State:CA
Practice Address - Zip Code:93446-3742
Practice Address - Country:US
Practice Address - Phone:805-226-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2014-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-18251363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA12317747OtherCAQH PROVIDER NUMBER
CAPA18251OtherPHYSICIAN ASSISTANT COMMITTEE CERTIFICATE NUMBER