Provider Demographics
NPI:1649533803
Name:LEWALLEN, ROBIN SCHROEDER (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:SCHROEDER
Last Name:LEWALLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:ROBIN
Other - Middle Name:ELAINE
Other - Last Name:SCHROEDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 702
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7708
Mailing Address - Country:US
Mailing Address - Phone:949-759-2100
Mailing Address - Fax:
Practice Address - Street 1:1441 AVOCADO AVE STE 702
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7708
Practice Address - Country:US
Practice Address - Phone:949-706-7886
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-21
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA144323207ND0101X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
No207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery