Provider Demographics
NPI:1942341508
Name:DIDOSZAK, ROBIN RENEE (RN, IBCLC)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:RENEE
Last Name:DIDOSZAK
Suffix:
Gender:F
Credentials:RN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3279 COVE WAY
Mailing Address - Street 2:
Mailing Address - City:MARINA
Mailing Address - State:CA
Mailing Address - Zip Code:93933-2231
Mailing Address - Country:US
Mailing Address - Phone:831-869-9308
Mailing Address - Fax:831-582-9270
Practice Address - Street 1:3160 OCEAN TER
Practice Address - Street 2:
Practice Address - City:MARINA
Practice Address - State:CA
Practice Address - Zip Code:93933-3291
Practice Address - Country:US
Practice Address - Phone:831-869-9308
Practice Address - Fax:831-582-8270
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA513908163W00000X
CA10622789163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered163W00000XNursing Service ProvidersRegistered Nurse
Not Answered163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA513908OtherREGISTERED NURSE
10622789OtherIBCLC