MEDICARE: ROBIN BLACK OGNP, FASCCP

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	261QA0005X	Ambulatory Family Planning Facility	RN268672	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1841419793
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBIN BLACK OGNP, FASCCP

Provider Business Mailing Address
First Line	:	559 GIOTTO
Second Line	:
City	:	IRVINE
State	:	CA
Zip	:	92614-8567
Country	:	US
Telephone Number	:	949-929-2100
Fax Number	:

Provider Business Practice Location Address
First Line	:	2077 HARBOR BLVD
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92627-2630
Country	:	US
Telephone Number	:	949-722-2510
Fax Number	:	949-722-2511

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

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/09/2007

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