Provider Demographics
NPI:1942374616
Name:ROBLES-KORTMEYER, EDITH (DC)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:
Last Name:ROBLES-KORTMEYER
Suffix:
Gender:F
Credentials:DC
Other - Prefix:
Other - First Name:EDITH
Other - Middle Name:
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1843
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92235-1843
Mailing Address - Country:US
Mailing Address - Phone:760-321-1453
Mailing Address - Fax:760-324-6656
Practice Address - Street 1:34-950 DATE PALM DRIVE
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-6833
Practice Address - Country:US
Practice Address - Phone:760-321-1453
Practice Address - Fax:760-324-6656
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC22829111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADC022829Medicaid
CADC022829Medicaid
DC0228290Medicare ID - Type Unspecified