Healthcare Provider Details

I. General information

NPI: 1558439653
Provider Name (Legal Business Name): ROBERT H HINES JR. M.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/30/2006
Last Update Date: 10/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 HARBOR DR SUITE 115
SAUSALITO CA
94965-1454
US

IV. Provider business mailing address

3 HARBOR DR SUITE 115
SAUSALITO CA
94965-1454
US

V. Phone/Fax

Practice location:
  • Phone: 415-380-0480
  • Fax: 415-380-8788
Mailing address:
  • Phone: 415-380-0480
  • Fax: 415-380-8788

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License NumberC39226
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: