Healthcare Provider Details

I. General information

NPI: 1932042579
Provider Name (Legal Business Name): MR. RORY ROBINSON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2026
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

152 E 111TH ST
LOS ANGELES CA
90061-2532
US

IV. Provider business mailing address

152 E 111TH ST
LOS ANGELES CA
90061-2532
US

V. Phone/Fax

Practice location:
  • Phone: 213-563-0570
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: