Provider Demographics
NPI:1386219970
Name:BRANNOCK, ROBIN LEE
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:LEE
Last Name:BRANNOCK
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 1:954 60TH ST STE 10
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2369
Mailing Address - Country:US
Mailing Address - Phone:510-835-5010
Mailing Address - Fax:
Practice Address - Street 1:954 60TH ST STE 10
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2369
Practice Address - Country:US
Practice Address - Phone:510-835-5010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-25
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0136172V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker