Provider Demographics
NPI:1609090281
Name:ROBERTS, MILES JULIAN (L AC)
Entity Type:Individual
Prefix:MR
First Name:MILES
Middle Name:JULIAN
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:L AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3050
Mailing Address - Country:US
Mailing Address - Phone:916-483-0743
Mailing Address - Fax:
Practice Address - Street 1:3504 WALNUT AVE
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3050
Practice Address - Country:US
Practice Address - Phone:916-483-0743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC1099171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist