Provider Demographics
NPI:1932342250
Name:ROBERT C MACKIN
Entity Type:Organization
Organization Name:ROBERT C MACKIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:NATION
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-385-6400
Mailing Address - Street 1:406 CANAL ST
Mailing Address - Street 2:
Mailing Address - City:KING CITY
Mailing Address - State:CA
Mailing Address - Zip Code:93930-3412
Mailing Address - Country:US
Mailing Address - Phone:831-385-6400
Mailing Address - Fax:831-385-1015
Practice Address - Street 1:406 CANAL ST
Practice Address - Street 2:
Practice Address - City:KING CITY
Practice Address - State:CA
Practice Address - Zip Code:93930-3412
Practice Address - Country:US
Practice Address - Phone:831-385-6400
Practice Address - Fax:831-385-1015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-16
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CASD0093020332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0692000001Medicare NSC