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General NPI Number Information
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NPI Number | 1508732280
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Entity Type | Individual
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Provider Name | DUSTY MARK SHANE ROBELLO LVN
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Gender | Male
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Dates
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Enumeration Date | 10/11/2025
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Last Update Date | 10/11/2025
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Provider Practice Location Address
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Address Line | 4675 CAMINO TASSAJARA
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City | DANVILLE
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State | CA
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Zip | 94506-5904
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Country | US
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Telephone | 925-855-7800
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Fax |
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Provider Business Mailing Address
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Address Line | 631 AMBERSTONE LN
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City | SAN RAMON
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State | CA
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Zip | 94582-5741
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Country | US
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Telephone | 925-389-1134
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 164X00000X
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Taxonomy Name | Licensed Vocational Nurse
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License Number | 708488
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License Number State | CA
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