Provider Demographics
NPI:1851994750
Name:NIXON, ROBERT H
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:H
Last Name:NIXON
Suffix:
Gender:M
Credentials:
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 26184
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92196-0184
Mailing Address - Country:US
Mailing Address - Phone:858-449-4743
Mailing Address - Fax:
Practice Address - Street 1:929 9TH AVE APT 1518
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-5553
Practice Address - Country:US
Practice Address - Phone:858-449-4743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-21
Last Update Date:2020-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7YSX040347C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes347C00000XTransportation ServicesPrivate Vehicle