Healthcare Provider Details

I. General information

NPI: 1558554071
Provider Name (Legal Business Name): MICHAEL JAY ROBISON
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2007
Last Update Date: 09/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5351 CARPINTERIA AVE
CARPINTERIA CA
93013-2101
US

IV. Provider business mailing address

1763 N 5TH ST
PORT HUENEME CA
93041-2210
US

V. Phone/Fax

Practice location:
  • Phone: 805-684-4544
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number55912
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: