Healthcare Provider Details

I. General information

NPI: 1124392246
Provider Name (Legal Business Name): ROBIN POWELL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/07/2012
Last Update Date: 03/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13001 RAMONA BLVD STE. I
IRWINDALE CA
91706-3752
US

IV. Provider business mailing address

2506 MAYFIELD AVE
MONTROSE CA
91020-1416
US

V. Phone/Fax

Practice location:
  • Phone: 626-337-3828
  • Fax:
Mailing address:
  • Phone: 323-377-7970
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: