Provider Demographics
NPI:1649276684
Name:COLE, ROBIN R (MD)
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:R
Last Name:COLE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 N ROSE DR
Mailing Address - Street 2:STE 202
Mailing Address - City:PLACENTIA
Mailing Address - State:CA
Mailing Address - Zip Code:92870-3840
Mailing Address - Country:US
Mailing Address - Phone:714-203-1500
Mailing Address - Fax:714-203-1711
Practice Address - Street 1:1325 N ROSE DR
Practice Address - Street 2:STE 202
Practice Address - City:PLACENTIA
Practice Address - State:CA
Practice Address - Zip Code:92870-3840
Practice Address - Country:US
Practice Address - Phone:714-203-1500
Practice Address - Fax:714-203-1711
Is Sole Proprietor?:No
Enumeration Date:2005-06-23
Last Update Date:2010-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA84827208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A848270Medicaid
CA00A848270Medicaid
CAH84827Medicare UPIN