Provider Demographics
NPI:1902039894
Name:DIANE M. ROBARTS, DOM, PA
Entity Type:Organization
Organization Name:DIANE M. ROBARTS, DOM, PA
Other - Org Name:DIANE ROBARTS ACUPUNCTURE
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ROBARTS
Authorized Official - Suffix:
Authorized Official - Credentials:DOM, LAC
Authorized Official - Phone:941-485-3300
Mailing Address - Street 1:312 E VENICE AVE
Mailing Address - Street 2:SUITE 113
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-4677
Mailing Address - Country:US
Mailing Address - Phone:941-485-3300
Mailing Address - Fax:
Practice Address - Street 1:312 E VENICE AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-4677
Practice Address - Country:US
Practice Address - Phone:941-485-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2205171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty