Provider Demographics
NPI:1376624718
Name:ROBINSON, JEROME ALBERT (MD)
Entity Type:Individual
Prefix:
First Name:JEROME
Middle Name:ALBERT
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:PO BOX 399
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-0399
Mailing Address - Country:US
Mailing Address - Phone:619-991-9068
Mailing Address - Fax:619-267-8755
Practice Address - Street 1:655 EUCLID AVE
Practice Address - Street 2:SUITE 208
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2957
Practice Address - Country:US
Practice Address - Phone:619-267-8100
Practice Address - Fax:619-267-8755
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2017-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA30815207RC0000X, 207RI0011X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A3081500Medicaid
CA00A3081500Medicaid
CAWA30815BMedicare PIN