Provider Demographics
NPI:1245377050
Name:BELLE, ROBIN M
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:M
Last Name:BELLE
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 1:55475 SANTA FE TRL
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-3117
Mailing Address - Country:US
Mailing Address - Phone:760-365-3022
Mailing Address - Fax:760-365-3513
Practice Address - Street 1:58945 BUSINESS CENTER DR STE E
Practice Address - Street 2:
Practice Address - City:YUCCA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92284-7310
Practice Address - Country:US
Practice Address - Phone:760-365-3022
Practice Address - Fax:760-365-3513
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2019-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1245377050Medicaid