Provider Demographics
NPI:1437695384
Name:ROBERGE, BARBARA LEE (NP)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:LEE
Last Name:ROBERGE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2345 VISTA VALLE VERDE DR
Mailing Address - Street 2:
Mailing Address - City:FALLBROOK
Mailing Address - State:CA
Mailing Address - Zip Code:92028-8366
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1212 KELLWILL WAY
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-3322
Practice Address - Country:US
Practice Address - Phone:626-599-5222
Practice Address - Fax:626-599-5274
Is Sole Proprietor?:No
Enumeration Date:2017-01-17
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANP 3518363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics