Healthcare Provider Details

I. General information

NPI: 1255294096
Provider Name (Legal Business Name): OMG CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2025
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 E ORANGE GROVE AVE STE D
BURBANK CA
91502-1240
US

IV. Provider business mailing address

255 E ORANGE GROVE AVE STE D
BURBANK CA
91502-1240
US

V. Phone/Fax

Practice location:
  • Phone: 747-262-1155
  • Fax: 747-262-1154
Mailing address:
  • Phone: 747-262-1155
  • Fax: 747-262-1154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. JEFFREY LEE ROBINSON
Title or Position: ATTENDING PHYSICIAN CEO
Credential: MD
Phone: 747-262-1155