Healthcare Provider Details

I. General information

NPI: 1659296606
Provider Name (Legal Business Name): BRITTNEY SHANAE ROBINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/11/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12021 WILMINGTON AVE UNIT 4A
LOS ANGELES CA
90059-3019
US

IV. Provider business mailing address

700 E MOUNTAIN ST APT B8
PASADENA CA
91104-4569
US

V. Phone/Fax

Practice location:
  • Phone: 424-454-5407
  • Fax:
Mailing address:
  • Phone: 424-494-7175
  • Fax: 424-494-7175

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number3902
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: