Individual provider Active NPI

Dorothy Sue Robertson, FNP

  • Family Nurse Practitioner
  • Rialto, CA
National Provider Identifier
1508004763
Registry record updated Jan 27, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
16423 Issued in CA
Practice address
182 E Walnut Ave
Rialto, CA 92376-3530
Phone
(909) 820-7700
NPI assigned
Jan 27, 2009
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 27, 2009

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
General Practice Registered Nurse 163WG0000X 507554 CA
Family Nurse Practitioner 363LF0000X 16423 CA Primary

Addresses

Primary practice location

182 E Walnut Ave
Rialto, CA 92376-3530

Mailing address

7947 San Gorgonio St
Fontana, CA 92336-3919
Phone (909) 899-3062

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
507554CAMDGeneral Practice Registered Nurse
16423CAMDFamily Nurse Practitioner

NPI Registry JSON

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

{
    "created_epoch": "1233014400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233014400000",
    "number": "1508004763",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7947 SAN GORGONIO ST",
            "city": "FONTANA",
            "state": "CA",
            "postal_code": "923363919",
            "telephone_number": "909-899-3062"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "182 E WALNUT AVE",
            "city": "RIALTO",
            "state": "CA",
            "postal_code": "923763530",
            "telephone_number": "909-820-7700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "DOROTHY",
        "middle_name": "SUE",
        "credential": "FNP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-01-27",
        "last_updated": "2009-01-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WG0000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse, General Practice",
            "state": "CA",
            "license": "507554",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "CA",
            "license": "16423",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Rialto, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 27, 2009; 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.