Provider Demographics
NPI:1962722108
Name:ROBERTS, TODD M (DO)
Entity type:Individual
Prefix:DR
First Name:TODD
Middle Name:M
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5987
Mailing Address - Country:US
Mailing Address - Phone:951-698-8222
Mailing Address - Fax:951-698-7411
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-8222
Practice Address - Fax:951-698-7411
Is Sole Proprietor?:No
Enumeration Date:2010-06-10
Last Update Date:2016-01-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAOT013763207YS0123X
CA20A13954207YX0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0905XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngology/Facial Plastic Surgery
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery