Provider Demographics
NPI:1104237270
Name:ROBERTS, VALERIE
Entity type:Individual
Prefix:
First Name:VALERIE
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3147 KAHIWA PL
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96822-1544
Mailing Address - Country:US
Mailing Address - Phone:808-753-0145
Mailing Address - Fax:855-509-0220
Practice Address - Street 1:3147 KAHIWA PL
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96822-1544
Practice Address - Country:US
Practice Address - Phone:808-753-0145
Practice Address - Fax:855-509-0220
Is Sole Proprietor?:No
Enumeration Date:2014-05-12
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI72-LD133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered