Provider Demographics
NPI:1326088527
Name:ROBERTSON, VIRGIL L (DC, NP-C)
Entity Type:Individual
Prefix:DR
First Name:VIRGIL
Middle Name:L
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:DC, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 N BREA BLVD
Mailing Address - Street 2:SUITE G
Mailing Address - City:BREA
Mailing Address - State:CA
Mailing Address - Zip Code:92821-3336
Mailing Address - Country:US
Mailing Address - Phone:714-671-1150
Mailing Address - Fax:714-671-0833
Practice Address - Street 1:710 N BREA BLVD
Practice Address - Street 2:SUITE G
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-3336
Practice Address - Country:US
Practice Address - Phone:714-671-1150
Practice Address - Fax:714-671-0833
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-07
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA16831111N00000X
CANP21894363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAT82635Medicare UPIN