Provider Demographics
NPI:1629143904
Name:ROBISON, DONALD MARK I (LMT)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:MARK
Last Name:ROBISON
Suffix:I
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 GALSWORTHY ST
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5317
Mailing Address - Country:US
Mailing Address - Phone:805-370-3199
Mailing Address - Fax:
Practice Address - Street 1:560 GALSWORTHY ST
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5317
Practice Address - Country:US
Practice Address - Phone:805-370-3199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA73516171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor