Provider Demographics
NPI:1386033017
Name:ROBERTSON, LESTER (PA- C)
Entity Type:Individual
Prefix:MR
First Name:LESTER
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PA- C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3991 MACARTHUR BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-3009
Mailing Address - Country:US
Mailing Address - Phone:949-720-3888
Mailing Address - Fax:714-902-1101
Practice Address - Street 1:3991 MACARTHUR BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-3009
Practice Address - Country:US
Practice Address - Phone:949-720-3888
Practice Address - Fax:714-902-1101
Is Sole Proprietor?:No
Enumeration Date:2015-01-19
Last Update Date:2015-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51465363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical