Basic Information
Provider Information
NPI: 1174607543
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: ASHLEY
FirstName: ROBERTA
MiddleName:  
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1520 SAN PABLO ST
Address2: SUITE 3451
City: LOS ANGELES
State: CA
PostalCode: 900335310
CountryCode: US
TelephoneNumber: 3234427400
FaxNumber: 3234427411
Practice Location
Address1: 1500 SAN PABLO ST
Address2: USC UNIVERSITY HOSPITAL
City: LOS ANGELES
State: CA
PostalCode: 900335313
CountryCode: US
TelephoneNumber: 3234427400
FaxNumber: 3234427411
Other Information
ProviderEnumerationDate: 10/24/2006
LastUpdateDate: 09/27/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X2998CAY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

No ID Information.


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