Provider Demographics
NPI:1558561860
Name:SMITH, ROBINA MICHELLE (MD)
Entity Type:Individual
Prefix:
First Name:ROBINA
Middle Name:MICHELLE
Last Name:SMITH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ROBINA
Other - Middle Name:MICHELLE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:279 IMPERIAL HWY
Mailing Address - Street 2:SUITE 730
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-1041
Mailing Address - Country:US
Mailing Address - Phone:714-449-4800
Mailing Address - Fax:714-449-4956
Practice Address - Street 1:2151 N HARBOR BLVD
Practice Address - Street 2:SUITE 3100
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92835-3820
Practice Address - Country:US
Practice Address - Phone:714-446-5296
Practice Address - Fax:714-446-5240
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2013-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100730208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA100730OtherCA MEDICAL LICENSE
CA0A1007300Medicaid
CA0A1007300Medicaid