Provider Demographics
NPI:1629342142
Name:ROBINSON, SANDRA RENAY (VN108512)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:RENAY
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:VN108512
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3410 LA SIERRA AVE.
Mailing Address - Street 2:#444F
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503
Mailing Address - Country:US
Mailing Address - Phone:951-202-0363
Mailing Address - Fax:
Practice Address - Street 1:2280 TREEMONT PLACE
Practice Address - Street 2:APT 104
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879
Practice Address - Country:US
Practice Address - Phone:951-202-0363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-01
Last Update Date:2012-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAVN108512164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse