Provider Demographics
NPI:1275725699
Name:ROBERTSON, DARLENE (COM)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:COM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 DIAMOND SPRINGS DR
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-1939
Mailing Address - Country:US
Mailing Address - Phone:713-410-1395
Mailing Address - Fax:281-493-5052
Practice Address - Street 1:2050 DIAMOND SPRINGS DR
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77077-1939
Practice Address - Country:US
Practice Address - Phone:713-410-1395
Practice Address - Fax:281-493-5052
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2007-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX03411174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist