Provider Demographics
NPI:1912212739
Name:OWEN L. ROBINSON MD, A MEDICAL CORPORATION
Entity Type:Organization
Organization Name:OWEN L. ROBINSON MD, A MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:OWEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBINSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-538-1381
Mailing Address - Street 1:1141 W REDONDO BEACH BLVD
Mailing Address - Street 2:STE 400
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-3586
Mailing Address - Country:US
Mailing Address - Phone:310-538-1381
Mailing Address - Fax:310-538-4900
Practice Address - Street 1:1141 W REDONDO BEACH BLVD
Practice Address - Street 2:STE 400
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-3586
Practice Address - Country:US
Practice Address - Phone:310-538-1381
Practice Address - Fax:310-538-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-17
Last Update Date:2010-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG47920207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G479200Medicaid
CAA50862Medicare UPIN