Provider Demographics
NPI:1881825024
Name:ROBERTSON, ROBIN C (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:C
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:10790 RANCHO BERNARDO RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92127-5705
Mailing Address - Country:US
Mailing Address - Phone:760-827-7530
Mailing Address - Fax:760-827-7425
Practice Address - Street 1:2176 SALK AVE
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92008-7346
Practice Address - Country:US
Practice Address - Phone:760-827-7530
Practice Address - Fax:760-827-7425
Is Sole Proprietor?:No
Enumeration Date:2009-08-05
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80815207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA4265030Medicaid
CAG40200Medicare UPIN