Provider Demographics
NPI:1689458465
Name:ROBERTSON, LAURA (CPT)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1285 STRATFORD AVE STE G
Mailing Address - Street 2:
Mailing Address - City:DIXON
Mailing Address - State:CA
Mailing Address - Zip Code:95620-2000
Mailing Address - Country:US
Mailing Address - Phone:707-235-7693
Mailing Address - Fax:
Practice Address - Street 1:840 ALEXANDER DR
Practice Address - Street 2:
Practice Address - City:DIXON
Practice Address - State:CA
Practice Address - Zip Code:95620-4102
Practice Address - Country:US
Practice Address - Phone:707-235-7693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-22
Last Update Date:2023-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT-00008561246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomyGroup - Single Specialty