Provider Demographics
NPI:1578943452
Name:ROBIN, GREGORY SHAUN (RN)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SHAUN
Last Name:ROBIN
Suffix:
Gender:M
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5649 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-7543
Mailing Address - Country:US
Mailing Address - Phone:561-635-3581
Mailing Address - Fax:
Practice Address - Street 1:600 B ST
Practice Address - Street 2:SUITE 1570
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-4520
Practice Address - Country:US
Practice Address - Phone:619-615-0439
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95049882163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse