Healthcare Provider Details

I. General information

NPI: 1619200854
Provider Name (Legal Business Name): AMANDA ROBINSON CNA,CHHA,,RCFE,GERO.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MS. MONDA ROBINSON

II. Dates (important events)

Enumeration Date: 09/04/2009
Last Update Date: 09/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4800 NEBO DR # 3903
LA MESA CA
91941-3824
US

IV. Provider business mailing address

PO BOX 3903
LA MESA CA
91944
US

V. Phone/Fax

Practice location:
  • Phone: 619-871-0521
  • Fax:
Mailing address:
  • Phone: 619-871-0521
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number0000000000000000
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: