=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417191339
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ERNEST B ROBINSON MD A PROFESSIONAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/22/2009
-----------------------------------------------------
Last Update Date | 12/29/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 24541 PACIFIC PARK DR. SUITE 103
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-831-5900
-----------------------------------------------------
Fax | 949-831-1782
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 24541 PACIFIC PARK DR. SUITE 103
-----------------------------------------------------
City | ALISO VIEJO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92656-3050
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 949-831-5900
-----------------------------------------------------
Fax | 949-831-1782
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PHYSICIAN/SURGEON
-----------------------------------------------------
Name | ERNEST B. ROBINSON
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 949-831-5900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM2500X
-----------------------------------------------------
Taxonomy Name | Medical Specialty Clinic/Center
-----------------------------------------------------
License Number | G073812
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------