Healthcare Provider Details

I. General information

NPI: 1699815217
Provider Name (Legal Business Name): PAUL M ROBINSON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 06/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

485 BROADWAY STREET SUITE # D
EL CENTRO CA
92243
US

IV. Provider business mailing address

485 BROADWAY ST SUITE # D
EL CENTRO CA
92243-2451
US

V. Phone/Fax

Practice location:
  • Phone: 310-301-3031
  • Fax: 310-301-3001
Mailing address:
  • Phone: 310-301-3031
  • Fax: 310-301-3001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberG72600
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberG72600
License Number StateCA

VIII. Authorized Official

Name: PAUL M ROBINSON
Title or Position: DIRECTOR
Credential: MD
Phone: 310-828-3031