Healthcare Provider Details

I. General information

NPI: 1316361124
Provider Name (Legal Business Name): DWAYNE ROBINSON CATC II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2014
Last Update Date: 08/18/2025
Certification Date: 08/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

570 W 4TH ST STE 216
SAN BERNARDINO CA
92401-1409
US

IV. Provider business mailing address

570 W 4TH ST STE 216
SAN BERNARDINO CA
92401-1409
US

V. Phone/Fax

Practice location:
  • Phone: 909-804-8877
  • Fax: 909-885-6852
Mailing address:
  • Phone: 909-804-8877
  • Fax: 909-885-6852

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberB5983996
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: