Healthcare Provider Details

I. General information

NPI: 1740731314
Provider Name (Legal Business Name): RONALD ROBBINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2016
Last Update Date: 10/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 WHITLEY AVE SUITE 301
LOS ANGELES CA
90028-4968
US

IV. Provider business mailing address

1850 WHITLEY AVE SUITE 301
LOS ANGELES CA
90028
US

V. Phone/Fax

Practice location:
  • Phone: 701-651-6887
  • Fax:
Mailing address:
  • Phone: 701-651-6887
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: