Healthcare Provider Details

I. General information

NPI: 1932288867
Provider Name (Legal Business Name): ROBIN BALOGH CRNFA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2006
Last Update Date: 08/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12061 E MISSION LANE CIR
SCOTTSDALE AZ
85259-6041
US

IV. Provider business mailing address

PO BOX 5135
SCOTTSDALE AZ
85261-5135
US

V. Phone/Fax

Practice location:
  • Phone: 602-418-8988
  • Fax:
Mailing address:
  • Phone: 480-545-2610
  • Fax: 480-545-2673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License NumberRN069911
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: