1447390067 NPI number — PAUL M ROBINSON MD

Table of content: PAUL M ROBINSON MD (NPI 1447390067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447390067 NPI number — PAUL M ROBINSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBINSON
Provider First Name:
PAUL
Provider Middle Name:
M
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:
1447390067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/22/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14069 MARQUESAS WAY
Provider Second Line Business Mailing Address:
SUITE 216D
Provider Business Mailing Address City Name:
MARINA DEL REY
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90292-6052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-301-3031
Provider Business Mailing Address Fax Number:
310-301-3001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
14069 MARQUESAS WAY
Provider Second Line Business Practice Location Address:
SUITE 216D
Provider Business Practice Location Address City Name:
MARINA DEL REY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90292-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-301-3031
Provider Business Practice Location Address Fax Number:
310-301-3001
Provider Enumeration Date:
02/07/2007

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: 208D00000X , with the licence number:  G72600 , 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: 00G726000 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00G726000 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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