Healthcare Provider Details

I. General information

NPI: 1902175276
Provider Name (Legal Business Name): ROBIN FORDHAM PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 10/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1234 W CHAPMAN AVE SUITE 101
ORANGE CA
92868-2862
US

IV. Provider business mailing address

1234 W CHAPMAN AVE SUITE 101
ORANGE CA
92868-2862
US

V. Phone/Fax

Practice location:
  • Phone: 714-532-6713
  • Fax: 714-532-1169
Mailing address:
  • Phone: 714-532-6713
  • Fax: 714-532-1169

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA16582
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: