Provider Demographics
NPI:1295582435
Name:ROBIN, KENT IAN CABALLERO
Entity type:Individual
Prefix:
First Name:KENT IAN
Middle Name:CABALLERO
Last Name:ROBIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20656 WYANDOTTE ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2749
Mailing Address - Country:US
Mailing Address - Phone:323-519-8717
Mailing Address - Fax:
Practice Address - Street 1:21550 OXNARD ST FL 3
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-7105
Practice Address - Country:US
Practice Address - Phone:747-288-3543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95028402363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health