Provider Demographics
NPI:1497013999
Name:ROBICHAUX, TRAVIS (SOIDC)
Entity Type:Individual
Prefix:
First Name:TRAVIS
Middle Name:
Last Name:ROBICHAUX
Suffix:
Gender:M
Credentials:SOIDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MCB BOX 555341
Mailing Address - Street 2:1ST MSOB
Mailing Address - City:CAMP PENDLETON
Mailing Address - State:CA
Mailing Address - Zip Code:92055-5341
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:20920 AREA 41 BLDG 41256
Practice Address - Street 2:1ST MARINE SPECIAL OPERATIONS BATTALLION
Practice Address - City:CAMP PENDLETON
Practice Address - State:CA
Practice Address - Zip Code:92055-5341
Practice Address - Country:US
Practice Address - Phone:760-725-5298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2012-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman