Provider Demographics
NPI:1922334549
Name:IRWIN, ROBERTA LYNNE (CMT, HHP)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:LYNNE
Last Name:IRWIN
Suffix:
Gender:F
Credentials:CMT, HHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4375 NARRAGANSETT AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2937
Mailing Address - Country:US
Mailing Address - Phone:619-246-1561
Mailing Address - Fax:
Practice Address - Street 1:2615 CAMINO DEL RIO S
Practice Address - Street 2:SUITE 100
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3713
Practice Address - Country:US
Practice Address - Phone:619-246-1561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-02
Last Update Date:2009-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist