Provider Demographics
NPI:1417025768
Name:ADLER, ROBERTA SUZANNE (MT-BC, NMT-ID)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:SUZANNE
Last Name:ADLER
Suffix:
Gender:F
Credentials:MT-BC, NMT-ID
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13171 COLEMAN PLACE
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92843-1217
Mailing Address - Country:US
Mailing Address - Phone:714-534-2855
Mailing Address - Fax:
Practice Address - Street 1:13171 COLEMAN PL
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92843-1217
Practice Address - Country:US
Practice Address - Phone:714-534-2855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA01534246ZA2600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZA2600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherArt, Medical
Provider Identifiers
StateIdentifier IDID TypeIssuer
01534OtherMT-BC