Provider Demographics
NPI:1083095111
Name:ROBENIOL, DON RAFAEL (MSN, RN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:RAFAEL
Last Name:ROBENIOL
Suffix:
Gender:M
Credentials:MSN, RN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 LONG BEACH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-5501
Mailing Address - Country:US
Mailing Address - Phone:562-437-6717
Mailing Address - Fax:562-437-5072
Practice Address - Street 1:1955 LONG BEACH BLVD STE 200
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-5501
Practice Address - Country:US
Practice Address - Phone:562-437-6717
Practice Address - Fax:562-437-5072
Is Sole Proprietor?:No
Enumeration Date:2015-06-15
Last Update Date:2022-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015157363LP0808X
CA95022472163W00000X, 390200000X, 163WC0400X, 163WR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163WR0400XNursing Service ProvidersRegistered NurseRehabilitation