Individual
TIMOTHY ROBERTS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4475
Mailing address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4475
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
657663
TX
367500000X
Certified Registered Nurse Anesthetist
Primary
95001006
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1578585-02
—
TX
01
—
84441U
BLUE SHIELD
TX
01
—
P00198584
RR/MEDICARE
TX
Enumeration date
04/06/2006
Last updated
04/06/2022
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