1114957941 NPI number — ROBIN ANDREW ALLEYNE MD.

Table of content: LASHICA M WILBURN (NPI 1003630690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114957941 NPI number — ROBIN ANDREW ALLEYNE MD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ALLEYNE
Provider First Name:
ROBIN
Provider Middle Name:
ANDREW
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114957941
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/17/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8510 BALBOA BLVD
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
NORTHRIDGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91325-5810
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
818-637-2000
Provider Business Mailing Address Fax Number:
818-654-3417

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7512 MORRO RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ATASCADERO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93422-4404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-792-1400
Provider Business Practice Location Address Fax Number:
805-792-1485
Provider Enumeration Date:
07/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  C51874 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: FHC70593F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: W1508C . This is a "MEDICARE GROUP'S PTAN-ATASCADERO" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: BG280Y . This is a "PTAN: TEMPLETON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W1508A . This is a "MEDICARE GROUP'S PTAN TEMPLETON" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1275550295 . This is a "PTAN: TEMPLETON BG280Y NPI#" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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