Provider Demographics
NPI:1619920006
Name:ROBINS, JON M (MD)
Entity Type:Individual
Prefix:
First Name:JON
Middle Name:M
Last Name:ROBINS
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:PO BOX 34307
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-4307
Mailing Address - Country:US
Mailing Address - Phone:866-727-1070
Mailing Address - Fax:877-883-5176
Practice Address - Street 1:501 WASHINGTON ST
Practice Address - Street 2:STE 510
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:866-558-4320
Practice Address - Fax:619-294-8399
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG127172085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G127170Medicaid
CA00G127170Medicare PIN
CA00G127170Medicaid
CA00G127171Medicare PIN
CAWG12717BMedicare PIN
CA00G127172Medicare PIN
A38770Medicare UPIN
CAWG12717HMedicare PIN
CAWG12717AMedicare PIN
CAWG12717IMedicare PIN
CAWG12717FMedicare PIN
CAWG12717GMedicare PIN