Healthcare Provider Details

I. General information

NPI: 1831191816
Provider Name (Legal Business Name): ROBIN RAINIE-LOBACZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BASILONE RD
CAMP PENDLETON CA
92055
US

IV. Provider business mailing address

PO BOX 555191
CAMP PENDLETON CA
92055-5191
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-7043
  • Fax: 760-725-1186
Mailing address:
  • Phone: 760-725-7043
  • Fax: 760-725-1186

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number16848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: