Healthcare Provider Details

I. General information

NPI: 1447222393
Provider Name (Legal Business Name): ROBERT ALAN PEDRIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1125 SIR FRANCIS DRAKE BLVD SUITE A
KENTFIELD CA
94904-1418
US

IV. Provider business mailing address

135 VIA LERIDA
GREENBRAE CA
94904-1211
US

V. Phone/Fax

Practice location:
  • Phone: 415-485-3525
  • Fax: 415-454-9093
Mailing address:
  • Phone: 415-461-3648
  • Fax: 415-461-2154

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA207830
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: