Healthcare Provider Details

I. General information

NPI: 1184848665
Provider Name (Legal Business Name): ROBIN HEERENS LYSNE M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ROBIN LOPEZ LYSNE M.A.

II. Dates (important events)

Enumeration Date: 04/13/2007
Last Update Date: 08/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

335 E LAKE AVE
WATSONVILLE CA
95076
US

IV. Provider business mailing address

335 EAST LAKE AVE
WATSONVILLE CA
95076
US

V. Phone/Fax

Practice location:
  • Phone: 831-728-6445
  • Fax: 831-761-6011
Mailing address:
  • Phone: 831-728-6445
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: