Healthcare Provider Details

I. General information

NPI: 1255018644
Provider Name (Legal Business Name): ROBIN AMBAT DEVEGA RNFA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2023
Last Update Date: 06/29/2023
Certification Date: 06/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8008 FROST ST STE 311
SAN DIEGO CA
92123-4288
US

IV. Provider business mailing address

8008 FROST ST STE 311
SAN DIEGO CA
92123-4288
US

V. Phone/Fax

Practice location:
  • Phone: 858-292-5175
  • Fax:
Mailing address:
  • Phone: 858-292-5175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WR0006X
TaxonomyRegistered Nurse First Assistant
License Number605896
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: