Provider Demographics
NPI:1417624123
Name:ROBERTS, BELITA SOFIA (RN, FNP)
Entity Type:Individual
Prefix:
First Name:BELITA
Middle Name:SOFIA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RN, FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4432 NIPOMO AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-2840
Mailing Address - Country:US
Mailing Address - Phone:562-841-3938
Mailing Address - Fax:
Practice Address - Street 1:1269 E ANAHEIM ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90813-3709
Practice Address - Country:US
Practice Address - Phone:562-841-3938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-30
Last Update Date:2022-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95018140363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily