Provider Demographics
NPI:1568553030
Name:TRUMBULL, ROBIN L (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:L
Last Name:TRUMBULL
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 1:2644 M ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-2826
Mailing Address - Country:US
Mailing Address - Phone:209-722-5308
Mailing Address - Fax:209-722-7480
Practice Address - Street 1:2644 M ST
Practice Address - Street 2:SUITE A
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-2826
Practice Address - Country:US
Practice Address - Phone:209-722-5308
Practice Address - Fax:209-722-7480
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG30670207Q00000X
CA05D0896736207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G306700Medicaid
CA94-2860675OtherPRIVATE INSURANCE
CAA44507Medicare UPIN
CA00G306700Medicaid