Provider Demographics
NPI:1205021078
Name:ROBINSON, JUSTIN ADAM (MA, RD, CSSD, CSCS)
Entity Type:Individual
Prefix:MR
First Name:JUSTIN
Middle Name:ADAM
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:MA, RD, CSSD, CSCS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6053 MOHLER ST
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92120-4206
Mailing Address - Country:US
Mailing Address - Phone:805-305-1055
Mailing Address - Fax:
Practice Address - Street 1:6053 MOHLER ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92120
Practice Address - Country:US
Practice Address - Phone:805-305-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-13
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA950738133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered