1366550188 NPI number — ROBI BURNS

Table of content: ROBI BURNS (NPI 1366550188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366550188 NPI number — ROBI BURNS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURNS
Provider First Name:
ROBI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KENT
Provider Other First Name:
ROBI
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1366550188
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/11/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2633 W HORIZON RIDGE PKWY
Provider Second Line Business Mailing Address:
STE 100
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
NV
Provider Business Mailing Address Postal Code:
89052-4833
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
702-427-0494
Provider Business Mailing Address Fax Number:
702-456-0856

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2633 W HORIZON RIDGE PKWY
Provider Second Line Business Practice Location Address:
#100
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
NV
Provider Business Practice Location Address Postal Code:
89052-4832
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-427-0494
Provider Business Practice Location Address Fax Number:
702-456-0856
Provider Enumeration Date:
08/29/2006

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: 207V00000X , with the licence number:  10745 , registered in the state of NV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100502389 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".




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