Provider Demographics
NPI:1922195387
Name:KNUTTEL, ROBIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:KNUTTEL
Suffix:
Gender:F
Credentials:MD
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 1387
Mailing Address - Street 2:
Mailing Address - City:SONOMA
Mailing Address - State:CA
Mailing Address - Zip Code:95476-1387
Mailing Address - Country:US
Mailing Address - Phone:707-938-9880
Mailing Address - Fax:707-938-9879
Practice Address - Street 1:181 ANDRIEUX STREET
Practice Address - Street 2:SUITE 103
Practice Address - City:SONOMA
Practice Address - State:CA
Practice Address - Zip Code:95476
Practice Address - Country:US
Practice Address - Phone:707-938-9880
Practice Address - Fax:707-938-9879
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG066876207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF04530Medicare UPIN
CA00G668761Medicare ID - Type Unspecified