Provider Demographics
NPI:1255915716
Name:DIBIASE, ROBIN SCOTT (NP)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:SCOTT
Last Name:DIBIASE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:LOUISE
Other - Last Name:SCOTT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:715 TANK FARM RD STE C
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-7068
Mailing Address - Country:US
Mailing Address - Phone:805-543-5577
Mailing Address - Fax:805-595-3231
Practice Address - Street 1:715 TANK FARM RD STE C
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-7068
Practice Address - Country:US
Practice Address - Phone:805-543-5577
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-11
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95017297363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner