Individual provider Active NPI

Marilyn Roberts, RPA

  • Radiology Practitioner Assistant
  • Rancho Cucamonga, CA
National Provider Identifier
1124275276
Registry record updated Dec 16, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Radiology Practitioner AssistantTaxonomy code 243U00000X
License
08 FL 1335 Issued in UT
Practice address
8283 Grove Ave
Suite 101
Rancho Cucamonga, CA 91730-3137
Phone
(909) 982-8638
Fax
(909) 982-9618
NPI assigned
Aug 20, 2008
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 16, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Radiology Practitioner Assistant 243U00000X 08 FL 1335 UT Primary
Radiologic Technologist 247100000X RHF 94132 CA

Addresses

Primary practice location

8283 Grove Ave
Suite 101
Rancho Cucamonga, CA 91730-3137

Mailing address

6560 Westmont Ave
Rancho Cucamonga, CA 91701-9100
Phone (909) 244-0658

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
08 FL 1335UTMDRadiology Practitioner Assistant
RHF 94132CAMDRadiologic Technologist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1219190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1387152000000",
    "number": "1124275276",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6560 WESTMONT AVE",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917019100",
            "telephone_number": "909-244-0658",
            "fax_number": "909-244-9198"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8283 GROVE AVE",
            "address_2": "SUITE 101",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917303137",
            "telephone_number": "909-982-8638",
            "fax_number": "909-982-9618"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "MARILYN",
        "credential": "RPA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-08-20",
        "last_updated": "2013-12-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "243U00000X",
            "taxonomy_group": "",
            "desc": "Radiology Practitioner Assistant",
            "state": "UT",
            "license": "08 FL 1335",
            "primary": true
        },
        {
            "code": "247100000X",
            "taxonomy_group": "",
            "desc": "Radiologic Technologist",
            "state": "CA",
            "license": "RHF 94132",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.