Provider Demographics
NPI:1437417094
Name:ROBERTS, JENNIFER E (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:E
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JENNIFER
Other - Middle Name:
Other - Last Name:GARDNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1480 MORAGA RD
Mailing Address - Street 2:SUITE C #180
Mailing Address - City:MORAGA
Mailing Address - State:CA
Mailing Address - Zip Code:94556-2802
Mailing Address - Country:US
Mailing Address - Phone:415-715-9499
Mailing Address - Fax:510-296-7450
Practice Address - Street 1:1480 MORAGA RD
Practice Address - Street 2:SUITE C #180
Practice Address - City:MORAGA
Practice Address - State:CA
Practice Address - Zip Code:94556-2802
Practice Address - Country:US
Practice Address - Phone:415-715-9499
Practice Address - Fax:510-296-7450
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2020-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA1304372084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry