MEDICARE: ROBIN LYNN VAN BUREN CCC-SLP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	235Z00000X	Speech-Language Pathologist	SP 11954	CA

General Provider Information

NPI Number	:	1093953929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN LYNN VAN BUREN CCC-SLP

Provider Business Mailing Address
First Line	:	3629 W MACARTHUR BLVD STE 209
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6844
Country	:	US
Telephone Number	:	714-241-8815
Fax Number	:	714-551-8817

Provider Business Practice Location Address
First Line	:	2961 W MACARTHUR BLVD
Second Line	:	127
City	:	SANTA ANA
State	:	CA
Zip	:	92704-6913
Country	:	US
Telephone Number	:	714-241-8815
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/30/2009
Last Update Date	:	09/10/2020

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