Provider Demographics
NPI:1972200640
Name:ROBINSON, STACEY DENISE
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:DENISE
Last Name:ROBINSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5465 ALVERN CIR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-1921
Mailing Address - Country:US
Mailing Address - Phone:424-219-2348
Mailing Address - Fax:
Practice Address - Street 1:5465 ALVERN CIR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90045-1921
Practice Address - Country:US
Practice Address - Phone:424-219-2348
Practice Address - Fax:424-393-4285
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA001080364253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care