Provider Demographics
NPI:1174607543
Name:ASHLEY, ROBERTA
Entity type:Individual
Prefix:DR
First Name:ROBERTA
Middle Name:
Last Name:ASHLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 SAN PABLO ST
Mailing Address - Street 2:SUITE 3451
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90033-5310
Mailing Address - Country:US
Mailing Address - Phone:323-442-7400
Mailing Address - Fax:323-442-7411
Practice Address - Street 1:1500 SAN PABLO ST
Practice Address - Street 2:USC UNIVERSITY HOSPITAL
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5313
Practice Address - Country:US
Practice Address - Phone:323-442-7400
Practice Address - Fax:323-442-7411
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2998367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW809BMedicare ID - Type UnspecifiedHUDSON
CAW932Medicare ID - Type UnspecifiedHEALTH CENTER
CAW809AMedicare ID - Type UnspecifiedROYBAL
CAFD308ZMedicare PIN
CAW809FMedicare ID - Type UnspecifiedEL MONTE