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NPI Code Detail

MEDICARE: ROBIN ELIZABETH MOCK AU.D

MEDICARE: ROBIN ELIZABETH MOCK AU.D
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
1237600000XAudiologist-Hearing Aid FitterAU2603CA

General Provider Information

NPI Number : 1912269275
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBIN ELIZABETH MOCK AU.D
Provider Business Mailing Address
First Line : 475 WASHINGTON BLVD
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5287
Country : US
Telephone Number : 310-439-3736
Fax Number :
Provider Business Practice Location Address
First Line : 475 WASHINGTON BLVD
Second Line :
City : MARINA DEL REY
State : CA
Zip : 90292-5287
Country : US
Telephone Number : 310-439-3736
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/12/2012
Last Update Date : 12/08/2016

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