Provider Demographics
NPI:1477696078
Name:ROBINSON, NINA C (DPM)
Entity Type:Individual
Prefix:DR
First Name:NINA
Middle Name:C
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:DPM
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 3267
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-1267
Mailing Address - Country:US
Mailing Address - Phone:323-898-5787
Mailing Address - Fax:310-676-7715
Practice Address - Street 1:240 S LA CIENEGA BLVD
Practice Address - Street 2:#300
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-3324
Practice Address - Country:US
Practice Address - Phone:310-652-3668
Practice Address - Fax:310-676-7715
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2012-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC005965213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE4721OtherDPM LICENSE
CA11749466OtherCAQH
CAE4721OtherDPM LICENSE
CA6132370001Medicare NSC
CAE4721Medicare PIN