Provider Demographics
NPI:1407806961
Name:VIETH, ROBYN D (MD)
Entity Type:Individual
Prefix:
First Name:ROBYN
Middle Name:D
Last Name:VIETH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LAGUNA RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3601
Mailing Address - Country:US
Mailing Address - Phone:714-992-5350
Mailing Address - Fax:714-992-8156
Practice Address - Street 1:101 LAGUNA RD STE 100
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3601
Practice Address - Country:US
Practice Address - Phone:714-992-5350
Practice Address - Fax:714-992-8156
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72812174400000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGO754YMedicare PIN
CAA72812Medicare ID - Type Unspecified