Healthcare Provider Details

I. General information

NPI: 1689437923
Provider Name (Legal Business Name): ROBIN HTOO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2024
Last Update Date: 01/31/2024
Certification Date: 01/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 UNIVERSITY AVE W STE 181
SAINT PAUL MN
55104-2879
US

IV. Provider business mailing address

1821 UNIVERSITY AVE W STE 181
SAINT PAUL MN
55104-2879
US

V. Phone/Fax

Practice location:
  • Phone: 161-225-9771
  • Fax: 612-259-7889
Mailing address:
  • Phone: 161-225-9771
  • Fax: 612-259-7889

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: