Provider Demographics
NPI:1407917008
Name:HENRICHSEN, ROBERT K (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:K
Last Name:HENRICHSEN
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 1:11720 EDUCATION ST
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:AUBURN
Mailing Address - State:CA
Mailing Address - Zip Code:95602-2419
Mailing Address - Country:US
Mailing Address - Phone:530-885-0674
Mailing Address - Fax:530-885-7179
Practice Address - Street 1:11720 EDUCATION ST
Practice Address - Street 2:SUITE ONE
Practice Address - City:AUBURN
Practice Address - State:CA
Practice Address - Zip Code:95602-2419
Practice Address - Country:US
Practice Address - Phone:530-885-0674
Practice Address - Fax:530-885-7179
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG14911174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAP863OtherMEDICARE PTAN
CAG14911OtherMEDICAL LICENSE
CAG14911OtherMEDICAL LICENSE
CAAP863OtherMEDICARE PTAN
CAAH1364481OtherDEA NUMBER
CA942249850OtherFEDERAL TAX ID NUMBER