Provider Demographics
NPI:1639478191
Name:ROBERTSON, ASHA M (MD)
Entity type:Individual
Prefix:
First Name:ASHA
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:ASHA
Other - Middle Name:PRAKASH
Other - Last Name:MANSUKHANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:363 PLAYA DEL SUR APT 21
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-5961
Mailing Address - Country:US
Mailing Address - Phone:310-720-4395
Mailing Address - Fax:
Practice Address - Street 1:363 PLAYA DEL SUR APT 21
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-5961
Practice Address - Country:US
Practice Address - Phone:310-720-4395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-03-23
Last Update Date:2017-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA124302207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program