Healthcare Provider Details

I. General information

NPI: 1083095111
Provider Name (Legal Business Name): DON RAFAEL ROBENIOL MSN, RN, PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2015
Last Update Date: 09/13/2022
Certification Date: 09/13/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1955 LONG BEACH BLVD STE 200
LONG BEACH CA
90806-5501
US

IV. Provider business mailing address

1955 LONG BEACH BLVD STE 200
LONG BEACH CA
90806-5501
US

V. Phone/Fax

Practice location:
  • Phone: 562-437-6717
  • Fax: 562-437-5072
Mailing address:
  • Phone: 562-437-6717
  • Fax: 562-437-5072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95015157
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95022472
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number95022472
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number95022472
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code163WR0400X
TaxonomyRehabilitation Registered Nurse
License Number95022472
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: