Active NPI
Sidney Roberts
- Urology Physician
- Los Angeles, CA
National Provider Identifier
1245811108
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Urology Physician
- License
- STUDENT
- Practice address
- 1975 Zonal Ave
Los Angeles, CA 90089-5601 - Phone
- (310) 622-5592
- NPI assigned
- Apr 21, 2021
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Urology Physician | 208800000X | STUDENT | CA | Primary |
Addresses
Primary practice location
1975 Zonal Ave
Los Angeles, CA 90089-5601
Mailing address
10567 Rochester Ave
Los Angeles, CA 90024-6037
Phone (310) 622-5592
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
| License | State | Type | Specialty |
|---|---|---|---|
| STUDENT | CA | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1618963200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618963200000",
"number": "1245811108",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "10567 ROCHESTER AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900246037",
"telephone_number": "310-622-5592"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1975 ZONAL AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900895601",
"telephone_number": "310-622-5592"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SIDNEY",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-04-21",
"last_updated": "2021-04-21",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "208800000X",
"taxonomy_group": "",
"desc": "Urology",
"state": "CA",
"license": "STUDENT",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.