Healthcare Provider Details

I. General information

NPI: 1932036142
Provider Name (Legal Business Name): ROBERT ATKINSON DOCTORAL INTERN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2026
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23554 WESTERN AVE UNIT B
HARBOR CITY CA
90710-1033
US

IV. Provider business mailing address

23554 WESTERN AVE UNIT B
HARBOR CITY CA
90710-1033
US

V. Phone/Fax

Practice location:
  • Phone: 310-621-6347
  • Fax:
Mailing address:
  • Phone: 310-621-6347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: