Provider Demographics
NPI:1811917180
Name:ROBARTS, DIANE M (DOM, LAC)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:M
Last Name:ROBARTS
Suffix:
Gender:F
Credentials:DOM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLAP2205171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist