Healthcare Provider Details

I. General information

NPI: 1396089512
Provider Name (Legal Business Name): ROBYN NICOLE GEORGE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBYN NICOLE HALLAM M.D.

II. Dates (important events)

Enumeration Date: 11/15/2012
Last Update Date: 01/10/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SERENO DR
VALLEJO CA
94589-2441
US

IV. Provider business mailing address

975 SERENO DR
VALLEJO CA
94589-2441
US

V. Phone/Fax

Practice location:
  • Phone: 707-651-4174
  • Fax:
Mailing address:
  • Phone: 707-651-4174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number036135539
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA123461
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: