Healthcare Provider Details

I. General information

NPI: 1285761155
Provider Name (Legal Business Name): ROBYN LENORE BURNS PHN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10011 FUERTE DR
LA MESA CA
91941-4317
US

IV. Provider business mailing address

10011 FUERTE DR
LA MESA CA
91941-4317
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-4082
  • Fax: 619-528-4077
Mailing address:
  • Phone: 619-528-4082
  • Fax: 619-528-4077

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number226648
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: