Provider Demographics
NPI:1164175659
Name:ROBINSON, DESIREE NOEL
Entity Type:Individual
Prefix:
First Name:DESIREE
Middle Name:NOEL
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 N LEMON ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91764-3732
Mailing Address - Country:US
Mailing Address - Phone:909-984-2765
Mailing Address - Fax:
Practice Address - Street 1:410 N LEMON ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91764-3732
Practice Address - Country:US
Practice Address - Phone:909-984-2765
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-03
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACA36218111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor