Healthcare Provider Details

I. General information

NPI: 1811927668
Provider Name (Legal Business Name): KEVIN C ROBELL MA ATC EMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1928 SAINT MARYS RD
MORAGA CA
94556-2715
US

IV. Provider business mailing address

185 CALLE NOGALES
WALNUT CREEK CA
94597-2157
US

V. Phone/Fax

Practice location:
  • Phone: 925-631-4398
  • Fax: 925-631-8123
Mailing address:
  • Phone: 925-878-1532
  • Fax: 925-631-8123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: