Provider Demographics
NPI:1063451557
Name:ROBINSON, HARRISON L (MD)
Entity Type:Individual
Prefix:
First Name:HARRISON
Middle Name:L
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S HICKORY ST
Mailing Address - Street 2:#118
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4359
Mailing Address - Country:US
Mailing Address - Phone:760-432-6644
Mailing Address - Fax:760-739-8213
Practice Address - Street 1:215 S HICKORY ST
Practice Address - Street 2:#118
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4359
Practice Address - Country:US
Practice Address - Phone:760-432-6644
Practice Address - Fax:760-739-8213
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC53636207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC53636OtherCA LICENSE
CA082274150OtherMEDICARE
CA18997OtherCAP MPT
CA18997OtherCAP MPT