Provider Demographics
NPI:1629221593
Name:PATRICIA ROBERTS, LLC
Entity Type:Organization
Organization Name:PATRICIA ROBERTS, LLC
Other - Org Name:PATRICIA ROBERTS, M.D.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:623-594-6866
Mailing Address - Street 1:3624 W ANTHEM WAY
Mailing Address - Street 2:C108
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-0440
Mailing Address - Country:US
Mailing Address - Phone:623-594-6866
Mailing Address - Fax:
Practice Address - Street 1:3624 W ANTHEM WAY
Practice Address - Street 2:C108
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-0440
Practice Address - Country:US
Practice Address - Phone:623-594-6866
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-23
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ31523261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care