Healthcare Provider Details

I. General information

NPI: 1437134962
Provider Name (Legal Business Name): SCOTT P ROBIN LSA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 11/11/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4833 SARATOGA BLVD # 217
CORPUS CHRISTI TX
78413-2213
US

IV. Provider business mailing address

4833 SARATOGA BLVD # 217
CORPUS CHRISTI TX
78413-2213
US

V. Phone/Fax

Practice location:
  • Phone: 361-563-8868
  • Fax: 361-723-1564
Mailing address:
  • Phone: 361-563-8868
  • Fax: 361-723-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License NumberSA00090
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: