Provider Demographics
NPI:1609291970
Name:ROBERTSON, CLARE ELIZABETH
Entity Type:Individual
Prefix:
First Name:CLARE
Middle Name:ELIZABETH
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5700 LOCHMOOR DR APT 235
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-8436
Mailing Address - Country:US
Mailing Address - Phone:805-451-7769
Mailing Address - Fax:
Practice Address - Street 1:5700 LOCHMOOR DR APT 235
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-8436
Practice Address - Country:US
Practice Address - Phone:805-451-7769
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-24
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program