Healthcare Provider Details

I. General information

NPI: 1720627789
Provider Name (Legal Business Name): ROBIN KUCHARIK FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2019
Last Update Date: 10/01/2024
Certification Date: 10/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5001 PACIFIC COAST HWY
TORRANCE CA
90505-5441
US

IV. Provider business mailing address

5001 PACIFIC COAST HWY
TORRANCE CA
90505-5441
US

V. Phone/Fax

Practice location:
  • Phone: 424-455-2274
  • Fax:
Mailing address:
  • Phone: 424-455-2273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95013352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: