Healthcare Provider Details

I. General information

NPI: 1942368949
Provider Name (Legal Business Name): ROBERT BRUCE CARLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/04/2006
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24953 PASEO DE VALENCIA SUITE 21B
LAGUNA HILLS CA
92653-4342
US

IV. Provider business mailing address

24953 PASEO DE VALENCIA SUITE 21B
LAGUNA HILLS CA
92653-4342
US

V. Phone/Fax

Practice location:
  • Phone: 949-770-7656
  • Fax: 949-770-2839
Mailing address:
  • Phone: 949-770-7656
  • Fax: 949-770-2839

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ND0900X
TaxonomyDermatopathology Physician
License NumberA24281
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: