Provider Demographics
NPI:1689663635
Name:ROBERTS, WENDY EILEEN (MD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:EILEEN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 115
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-346-4262
Mailing Address - Fax:760-340-9892
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 115
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-346-4262
Practice Address - Fax:760-340-9892
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-20
Last Update Date:2020-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG57257207N00000X, 207ND0900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAD43488Medicare UPIN
CA00G572571Medicare ID - Type Unspecified