1700015997 NPI number — DR. CELINE MARIE KO ROBERSON PH.D.

Table of content: DR. CELINE MARIE KO ROBERSON PH.D. (NPI 1700015997)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700015997 NPI number — DR. CELINE MARIE KO ROBERSON PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KO ROBERSON
Provider First Name:
CELINE
Provider Middle Name:
MARIE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KO
Provider Other First Name:
CELINE
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PH.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700015997
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2250 INDIGO HILLS DR
Provider Second Line Business Mailing Address:
#3
Provider Business Mailing Address City Name:
CORONA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92879-7920
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-310-3870
Provider Business Mailing Address Fax Number:
909-335-5305

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2250 INDIGO HILLS DR
Provider Second Line Business Practice Location Address:
#3
Provider Business Practice Location Address City Name:
CORONA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92879-7920
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-310-3870
Provider Business Practice Location Address Fax Number:
909-335-5305
Provider Enumeration Date:
07/08/2009

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: 103T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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